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.
Great things happen when we advocate together! After years of advocacy from BAYADA, our partners, and many parents and home care employees, the Maryland General Assembly recently passed two pieces of legislation that collectively will increase all Medicaid home and community-based services reimbursement rates by more than 30% over the next six years. Though initially met with opposition from Governor Larry Hogan, the Maryland General Assembly heard our voices and overwhelmingly voted to override his veto of one of the bills.
The first bill, the state’s annual budget, provides a rate increase of 3% that will go into effect July 1, 2019. The second bill, also effective July 1, 2019, contains an amendment which will increase reimbursement rates by 4% each year between July 1, 2020 and July 1, 2025.
Currently, Marylanders who rely on in-home nursing care have only 83% of their authorized hours filled, meaning that families struggle to fill their medically complex loved ones’ skilled home nursing care nearly 20% of the time! We have found that Medicaid rates have stagnated below the cost of living and below wages seen in other settings—such as hospitals and facilities—and surrounding states—and that families were struggling to fill these hours. We are hopeful that these access-to-care issues will be alleviated as providers will be able to recruit and retain nurses within the home care industry, and that more of Maryland’s most medically complex will be able to stay safe where they want to be—in their own homes.
This was a true team effort led by BAYADA and the Maryland National-Capital Area Home Care Association (MNCHA) and including MNCHA member providers, several individual families, parent advocacy organizations and disease-specific advocacy organizations. Special thanks to JoAnn Saxby, Patrick O’Malley, Eddie Dyer, Patty Watson, and Susan Ingallswho all played important parts in making this happen and to BAYADA Delaware employees Mandy Brady, Kristyn Kelsch, and Taylor Kosinski who went above and beyond to advocate in their sister state. Mike Sokoloski, Tara Montague, and Nicole Onofrio were instrumental in supporting two Town Halls and Legislative Day, and Alisa Fox coordinated timely articles in The Baltimore Sun, The Washington Post, and on WDVM TV in Western Maryland. Maggie Tracy managed countless logistical hurdles and supported direct lobbying and grassroots efforts.
Thank you to everyone who played a role in this major achievement! Advocacy cannot succeed if only one voice is heard, and your advocacy has contributed to the well-being of so many Marylanders in need of home care.
For more information on this increase, or how you can get involved in advocacy in Maryland, please contact Shannon Gahs at email@example.com.
We know the struggles families can face with home care: The call-outs and missed shifts, the lack of sleep, the caregivers who are like family but can’t afford to make their own ends meet, and the frustration that comes when you or your loved one can’t access the care that is deemed medically necessary. We also know the value and impact that sharing our voices has.
Recently, home care advocates have made the news for their efforts across the country. Specifically, on December 28, the Washington Post covered the impact that providers and parents are having in driving public awareness of the struggles that Marylanders and Virginians are having in accessing the skilled nursing home care their families need.
Washington Post reporter Tara Bahrampour points to low reimbursement rates in both states as the major issue contributing to families’ struggles—
“The reason lies in a stark state-by-state discrepancy in the pay in-home nurses receive through Medicaid. Maryland and Virginia have set reimbursement rates significantly lower than surrounding jurisdictions…As a result, licensed practical nurses [LPNs] are finding more lucrative positions out of state or at hospitals or other care institutions that pay more, leaving many homebound Medicaid patients without services.”
Hearts for Home Care has been leading the charge in Maryland, where a coalition of home care clients, parents, providers, and other advocates are pushing for a 25 percent increase for skilled home nursing services. Advocates say that this increase—half of which would have to come from state coffers—would serve to alleviate families’ inability to access care an average of 17 percent of the time, as reported by the state’s Department of Health. Hearts for Home Care advocate and BAYADA Home Health Care director Shannon Gahs says:
“Maryland is failing its citizens who have significant medical disabilities. Failing to provide care 17 percent of the time not only creates a dangerous situation for the person who relies on that care—it harms his or her family. Parents are calling out of work and losing the sleep they need to stay healthy to support their family. They’re doing everything they can to keep their family members safe, but this is not how it is supposed to be. We have to do better.”
In comparison, neighboring Delaware found that shifts are missed 7 percent of the time. There, the state reimburses providers at a rate approximately 30 percent higher for LPN home care services.
In California, Governor Jerry Brown recently proposed a whopping 50 percent wage increase for home care nurses—a move that advocates have pushed for over the past several years. As with families across the country, Californians who require skilled nursing home care have been struggling to get nursing care for their loved ones. Advocates report that under Medi-Cal—the state’s health care system for low income and disabled Californians—rates have not been addressed in 18 years.
While both the Maryland and California proposals are still pending, home care advocates have been successful in driving public and legislative awareness of low reimbursement rates and the impact on families’ access across the country in recent years. Most recently, the home care industry has seen reimbursement rate increases in Rhode Island, Massachusetts, South Carolina, and New Jersey among other states. It starts with educating legislators through advocacy via any number of channels: Traditional and social media, letters, phone calls, meetings, and more.
While advocacy can seem like an intimidating activity to many who do not yet engage in it, it’s important that we share our advocacy wins with the home care and health care community at-large. As illustrated in recent news, when we band together to leverage our voices in unison, big changes can happen. It’s important to take that first step and make your message heard on behalf of the millions of Americans that rely on home care.
The Maryland primary election at the end of June resulted in several big surprises. Longtime senator and well-respected chairman of the Senate Finance Committee, Mac Middleton, was ousted by a political unknown, shaking up the establishment and opening the question of who will lead this key committee. The primary defeat of Senator Steve Waugh, a moderate Republican known for thinking logically and building consensus made national news after Governor Larry Hogan came out against him for voting too often with Senate Democrats. When the dust settled, only one of the four major committee chairs in the Senate remained, and only two of the vice chairs. In the House, Delegate Joseph Vallario, a Maryland legend, lost his primary bid, creating a vacancy that had a chain reaction through the leadership as members took on new roles. These changes leave voids in institutional knowledge on the complicated issues that come before legislative committees.
In the Gubernatorial race, Governor Larry Hogan won the Republican primary and former NAACP Chair Ben Jealous was chosen for the Democratic nomination. Jealous has been vocal about bringing a single-payer healthcare system to Maryland, a move that the nonpartisan Department of Legislative Services has measured would add $24 billion to state expenses, but would eliminate the $51 billion Marylanders paid in healthcare costs in 2014 (an estimated $65 billion this year). Governor Hogan has been a supporter of stabilizing the ACA insurance market and keeping private coverage premiums down. For a state where healthcare is both a point of pride and a major economic generator, this is sure to be discussed often in the run-up to the election.
Across the state, primary elections re-affirmed the mantra that every vote counts. Results remained too close to call for days after the Baltimore County executive primary showed a win for former state Delegate Johnny Olszewski over state Senator Jim Brochin and County Councilwoman Vicki Almond by only nine votes. After a manual recount, the win was confirmed by a margin of 17 votes (of 84,601 total cast in the race). Legislative primaries across the state had similar results but garnered less attention. See Maryland’s elections website for the full results. If you have any questions about our legislative priorities for Maryland, don’t hesitate to reach out to me.
During session, Maryland-National Capital Homecare Association selected a new Executive Director. Dawn Seek, LPN, a longtime board member with a career in many aspects of home health care and durable medical equipment, was hired as the association’s sole full-time employee. She met with Dave Totaro and Shannon Gahs from the BAYADA Government Affairs Office (GAO) team last week to discuss her vision for the association and plans to work together in the coming year. Her plans include adding Maryland’s voice to the national conversation of the future of home health care, partnering with other organizations that serve our clients and employees in Maryland, building more substantive committees and planning meetings that have more immediately-actionable information for members.
Election season is officially upon us! The governorship and every seat in the legislature is on the ballot in 2018. Primary Day is on June 26 and the General Election will be November 6. Gov. Hogan, a popular Republican in a traditionally heavily Democratic state, faces an uphill battle. The field for the Democratic nomination currently has eight active candidates. Across the country, a blue wave is expected in November, with many Republicans expected to be unseated by Democrats. Maryland’s legislature currently stands at 123 Democrats to 64 Republicans. But no matter how the votes fall across party lines, the legislature is sure to include a lot of new faces in 2019–nearly 20% of senators have announced they will not run for re-election.
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.
At the end of the 2017 session, the Maryland General Assembly voted in favor of a statewide sick leave law. It was the sixth consecutive year that the bill was introduced.
The measure was fiercely debated and amended several times. The final version mandates that employees who work more than 12 hours in an average week earn paid sick leave at a rate of one hour per 30 hours worked, up to 64 hours per year. The sick leave may be used for the employee’s own sickness or that of a family member, to obtain preventative health care or to prevent domestic violence or stalking.
Following the 2017 session, Governor Larry Hogan vetoed the legislation, calling it bad for Maryland businesses. The legislature overrode the veto on the second day of session this year, January 11. It will go into effect 30 days after the override vote, pending a new bill introduced this week that would delay implementation. POL has been notified of the change and will issue guidance on how this will impact BAYADA offices.
If you have any questions about what’s going on in Maryland’s state capitol, let’s chat! Email me at firstname.lastname@example.org.
Both Delaware and Maryland have opened their 2018 legislative sessions and our advocacy work is in full swing. Delaware’s legislature will be open until June 30 in the second year of its two-year legislative session. The Maryland General Assembly is already nearly 20% over—as of today, there are 74 days left in the 90-day session.
Both sessions have been very busy already. Delaware and Maryland Hearts for Home Care Ambassadors and I have been working hard to reach legislators to educate and inform them about what home care means to our clients and families, and about what can be done to address the issues our industry faces every day.