Due to GAO’s advocacy efforts and that of our clients, employees, and industry partners, the Maryland legislature voted to increase Medicaid reimbursement rates for all home- and community-based services by 30% over the course of six years! In addition to traditional lobbying and grassroots advocacy efforts, the skilled nursing unit collaborated with GAO to deploy a public affairs campaign that led to home care clients’ stories being published in the Washington Post and Baltimore Sun, thus further showing legislators and the public the dire need for a Medicaid rate increase.
This monumental increase will enable BAYADA to compete for approximately 50% of the state’s LPNs, who are currently more attracted to hospitals and other settings where wages are higher. This in turn will enable BAYADA to better fulfill its vision of serving millions of people worldwide.
GAO anticipates that, as a result of this increase, the skilled nursing unit will open an office in 2020.
Recently, a Delaware pediatric licensed practical nurse
(LPN), Charlene Chappell, signed up for Hearts for Home Care and wanted to get
involved. And did she come out in full force!
After sharing powerful and heartfelt testimony in Dover,
DE’s Legislative Hall about the impact
she makes on families and the challenges low Medicaid rates bring to nurses who
want to provide one-on-one care to families at home, Charlene listened to a
radio show where host Joel Olsteen spoke about “an itch you just can’t
That got Charlene thinking about more advocacy. Charlene said, “I feel that the majority of men and women that serve as elected officials have no clue what’s required of a family when they have a child that has special needs and is differently abled! They don’t understand that nurses need to be attracted to home care so that families can rely on this care to keep their medically-complex children at home.”
That inspired her to write the below story and send it to all Delaware legislators. Read Charlene’s powerful story below!
I have an itch! Mo matter how hard I try to let someone know, I can’t. I’m 8 years old and I can’t tell Mommy where I itch! I can’t reach my itch! Its 2:30 in the morning and Mommy has fallen asleep in the chair next to my bed because she had to work today and then take my sister to her dance lesson. When she finally arrived home she threw some dirty laundry in the washer, and cooked dinner. After dinner she put the wash in the dryer, and then she loaded the dishwasher. She came in my room to check on me and feed me. Off she went to make sure my sister had done her homework and was in the shower. Oh no, an alarm is going off! Here comes Mommy. I wish I could tell her how much I love her for all she does and about my itch. She looks so tired. It’s almost 8:00 pm. The phone is ringing. Hurry Mommy before they hang up!
I can hear Mommy on the phone. “What! Oh no, please tell me it’s not true. I’m so tired tonight. I don’t know if I can stay up all night with him but I must. I have to make sure he’s ok on his ventilator and his medications are given at the right time, so he doesn’t have a seizure, and that the tube feeding is running properly. He has to be repositioned every two hours so his skin doesn’t break down. I have to check his diaper too. Well… thanks for the phone call.”
Oh no. Mommy just found out my favorite night nurse called out tonight, and the rest of forever. The agency is going to try and find a replacement as soon as possible, but that may take some time. Nurses aren’t as anxious to get into home health care nursing because they can make more money at a hospital. Mommy is going to miss work because she will have to stay up with me as Daddy’s gone from home with his job right now. Mommy may lose her job. I’m so sad my nurse left. She really knew me and she knew when I had an itch. She would gently scratch me all over till she found it, like Mommy does. She understands my cues and my facial expressions as I can’t talk, or walk, or move because of my illness.
I heard Mommy talking to the lady at the agency about the nursing shortage in home health care. She told Mommy that the money provided for reimbursement by Medicaid, not Medicare, has not increased in 13 years! The last time there was an increase in Medicaid was in 2006! I wasn’t even born then! She also told Mommy that the companies are running out of their own funds to supply the raises the nurses deserve. God bless the nurses that do work in home health care, for a lesser wage then they deserve, and take care of not only me but my mommy and Daddy too. Without them my Mommy and Daddy would not get the proper rest, would have to quit work to care for me. It would not be a good thing for my family. We would all suffer. I don’t want to go anywhere but here in my room. What if we can’t find a new night nurse? Where will I go? I overheard the doctors and nurses at the hospital talking last time I was admitted for a bad seizure and they said that all children do better in the home setting for getting well once they can leave the hospital. They are less likely to get sick again from a disease they acquired while in the hospital, and all of us are more comfortable in our own bed!
I hope my story has helped you to understand why we need to increase the Medicaid budget. Not Medicare, but Medicaid. Mommy told me that some people get confused so that’s why I will say it one more time. Please increase the Medicaid funding for home health care nurses.
Thank you for reading this. Mommy thanks you as well as all the other children and their parents that require specialized home health care nursing. And yes, Mommy found my itch!
Thank you, Charlene, for sharing your creative and passionate story with Delaware’s legislators. We must all share our voice to make an impact, and your advocacy highlights your deep commitment to your clients’ care.
Hearts for Home Care is seeking to advocate for higher reimbursement rates for skilled nursing services in Delaware so that nurses can be better attracted to home care, and so families that need this care to stay together at home can more easily and reliably access it. For information on how you can get involved, contact us today!
On March 6, 24 energetic BAYADA employees and one BAYADA Assistive Care State Programs (ACSP) client gathered in South Carolina’s state capitol for a day of meaningful and heartfelt advocacy. The South Carolina Home Care and Hospice Association (SCHCHA) hosted its second annual Legislative Advocacy Day, and this year, a record-breaking total of nearly 60 advocates attended!
BAYADA’s advocates joined other attendees and walked the halls with a clear message: Investing in our Nursing Medicaid Waiver programs will save the state money and keep our medically fragile children, disabled adults, and seniors home with their loved ones and out of higher cost facilities. We care about home care, and so should you!
With their passionate message in hand, advocates spoke with over 50 legislators about the importance of home care. This year we were able to speak to all key lawmakers in both the House and Senate to ensure our message was heard by as many ears–and the right ears–as possible.
“Advocacy can’t be effective with only one person working towards a goal–one voice can only go so far! That’s why I am so proud to work in South Carolina, where so many of our office employees, field employees, and clients recognize the importance of sharing their voices too. The more impassioned people we have involved, the more of a difference we can make on behalf of all South Carolinians that rely on home care,” said GAO director Melissa Allman.
BAYADA employees were excited and inspired by the impact they made that day. Thank you to the many participants for the difference you make on behalf of all South Carolinians that rely on home care to stay independent in their communities!
On February 21, seven BAYADA Home Health Care employees, one of whom is a parent and caregiver of a medically complex child, testified in front of a dozen Delaware state legislators and nearly 80 community members to advocate for a Medicaid reimbursement rate increase for registered nurses (RNs) and licensed practical nurses (LPNs).
The Delaware Joint Finance Committee met to hear the Department of Health and Social Services’ (DHSS) annual budget request in what ended up being a crowded room that drew so many members of the public that overflow seating had to be provided in the cafeteria, where a live video feed of the hearing was streamed. Though a few of these advocates were initially hesitant to speak in front of legislators- let alone such a crowd- what kept them going is their commitment to advocating on behalf of home care nurses, their clients, and their clients’ loved ones.
These advocates’ testimonies detailed their personal stories of why the committee should include additional funds to DHSS’s budget to be used to increase the state’s reimbursement rates for RN and LPN care by about 25%. Delaware’s current rates have not been increased in more than ten years, and these current rates are not adequate to keep up with demand for in-home nursing care because of the pressure that low rates place on providers’ ability to recruit and retain quality nurses. With a rate increase for RN and LPN care, providers would be able to attract more nurses to deliver the in-home care that pediatric, adult, and senior home care clients need.
BAYADA registered nurse Jen Saulsbury shared a moving story about two of her pediatric clients and the impact that nursing turnover rates, which stem from Delaware’s low reimbursement rates, has on them. She shared a crayon-drawn card from one of her pediatric clients to accompany her story, which nearly brought the committee to tears.
Committee co-chair Representative Melanie George-Smith and Senator Nicole Poore vocalized their support of increased reimbursement rates for RN and LPN care. It goes to show that advocacy is a powerful force in creating the changes necessary to support home care employees, clients, and their families.
Advocacy is powerful. The stories that these advocates shared in front of the committee were not those of data, numbers, and dollar signs, but rather their unique, passionate perspectives of why this issue is so important that it deserves legislative attention and action.
Advocacy doesn’t necessarily involve testifying in front of a crowded room. It can be sharing your unique story or picture with us, writing an email to a legislator, or participating in a meeting to talk about issues you face every day. A state-funded nursing rate increase cannot happen without getting other passionate individuals involved. If you would like to find out how you can to advocate for better home care laws and regulations, let’s talk about how you can get involved. Email me today!
At the end of June, 2017, through the efforts of our Ambassadors, our industry partners, our clients, and our legislative champions, the Rate Floor Bill passed the Delaware General Assembly.
This year, in the second year of Delaware’s two-year legislative session, our major legislative goal is to achieve an increase in the Medicaid fee schedule for RN and LPN hourly care. These two rates have stagnated since 2006. We are asking the legislature to update both according to the Consumer Price Index. Doing so would move LPN care from $46.14 to $56.01 and RN care from $51.50 to $62.51 per hour.
Our initial meetings with key members of the Joint Finance Committee have been very positive. We are working with them to include increased funding for this request in this year’s budget. If successful, our MCO contracts would have to be renegotiated so that reimbursement would be equal to or greater than the new fee schedule amounts.
This session, our major legislative goal in Maryland is to increase the Medicaid LPN rate across all programs and client groups from $34.16 to $42.81. It is an ambitious goal—initial budget estimates place the cost to the state at $26 million per year. With neighboring states reimbursing LPN care at $45, $46.14 and $50 per hour, it is easy to see why there is such a problem of access to care across Maryland. The low reimbursement simply does not support a sufficient wage to be able to consistently recruit and retain the skilled nurses that we need to be able to commit to serving a larger number of clients.
Problems within the Maryland Department of Health and a general lack of transparency have hindered this effort in past months. There have been a few targeted data points essential to such a large budget ask that BAYADA and Maryland-National Capital Homecare Association (MNCHA) through our best efforts, have been unable to obtain.
We started this session asking key legislative champions to help us get this information, using their political pressure to get information from the Department of Health or to introduce legislation that would establish an oversight working group to investigate the issue. Several legislators have been deeply troubled by the idea of children and adults with disabilities being unable to access the skilled nursing care they need to remain at home safely and have stepped up to help. This information, and the support we are gaining from those in key positions to move this effort through to becoming law, is a key step in increasing this LPN rate.
Thank you to Ambassadors Dan Guidebeck, Nikita Mutter, and Matt Paske for joining in legislative meetings and sharing the stories of how this issue impacts our clients and employees. Your commitment to advocacy reminds me of why we do what we do every day.
Submitted by Shannon Gahs, Director, DE Government Affairs (GAO)
The rate floor bill we’ve worked so hard on, now sits on Governor John Carney’s desk. Many bills passed in the last days of session, at the end of June, each requiring his consideration before he signs them into law or vetoes them. HB200, which sets a “rate floor” or minimum reimbursement rate for Registered Nurse (RN) and Licensed Practical Nurse (LPN) level nursing care equal to the Delaware Health and Social Services (DHSS) fee for service rates, would help ensure home health care clients across the state have access to care. We have sent him information about why this bill is so important to our clients and employees and we await his decision. The bill becomes law and is effective upon his signature.
Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)
The General Assembly, in the wee hours of the morning on the last day of session, passed the rate floor bill! This measure will ensure that Managed Care Organizations (MCOs) hourly home health care rates for registered nursing (RN) and licensed practical nursing (LPN) care will never fall below Delaware Health and Social Services (DHSS) hourly rates. This will help to ensure access to home health care for Delawareans with disabilities, and giving providers the ability to make informed business decisions. Dedicated effort by our BAYADA team of clients and employees, in partnership with the Delaware Association for Home and Community-Based Care and other home health care providers, made this possible. Thank you for your emails, phone calls, and attendance at Advocacy Day in Dover. This bill will go into effect when Governor John Carney signs it.
Submitted by Laura Ness, Director, PA Government Affairs (GAO)
Last week, during the Pennsylvania Homecare Association Annual Conference, Deputy Secretary for the Office of Long-Term Living (OLTL) Jen Burnett announced Managed Care Organizations (MCOs) will be required to reimburse providers at least the state posted fee-for-service reimbursement rate for personal assistant services. This “rate floor” will be in effect for the first 36 months post transition of each region. After the announcement, I had the opportunity to speak with Deputy Secretary Burnett, and she stated the reason OLTL made that decision was to provide stability for providers. During our conversation, I asked that her office consider extending the temporary rate floor to registered nurse (RN) and licensed practical nurse (LPN) services as well for the same reason. She invited us to meet with her formally to discuss. BAYADA’s Government Affairs Office (GAO) will work to set up a meeting with OLTL to lobby for the inclusion of RN and LPN services in the 36-month rate floor.