New York State Budget Finalized with $550 Million Increase Restored for Medicaid Funding

Earlier this year, New York Governor Andrew Cuomo announced his plan for the 2020 state budget, including a 3.6% planned budgeted increase to overall health care spending. When proposed tax revenue estimates came in much lower than anticipated, the administration decided to cut approximately $550 million of this increase. But after strong advocacy efforts from many health care groups across the state, the Governor and his administration changed their position, keeping the $550 million Medicaid increase in the budget.

BAYADA’s Government Affairs Office (GAO) participated in several conference calls with the New York State Home Care Association (HCA) to learn more about Medicaid spending, which accounts for 42% of the budget, and what we and our office staff, clients, and families can do to advocate for higher wages for home care nurses through increased reimbursement rates. 

Currently, New York’s Medicaid reimbursement rates are well-below surrounding states, so many caregivers are discouraged from entering—or staying in—the home care industry due to abysmal wages. It also impacts BAYADA because the rates are currently so low that we are currently not be able to provide sustainable Medicaid-based home care in the state and pay caregivers an appropriate wage.

As part of a larger national trend, New York did vote to increase the statewide minimum wage to $15 per hour incrementally through 2021. New York understands that home care providers that do provide Medicaid-based services would not be able to comply with this minimum wage mandate and stay sustainable under current rates. The final budget did include an additional $1.1 billion to support the cost of raising minimum wage for health care workers. BAYADA is currently advocating for similar increases in other GAO states that have increased the mandatory minimum wage, but have not increased reimbursement rates in tandem. Medicaid rates must keep pace with the rising cost of living and increased wage mandates to ensure that providers can stay in business, and to ensure that vulnerable New Yorkers can have access to quality home care.

New Jersey’s Legislative Goals and How You Can Help Make an Impact

BAYADA’s Government Affairs Office (GAO) is proud to join with fellow advocates like you to continue to advocate for better wages for our caregivers and increased access to home health care for the tens of thousands of New Jersey residents that rely on this care to stay safe and independent at home. Thank you to our many employees, clients, and families who have advocated on behalf of yourselves, your loved ones, your staff, and your clients regarding our two major 2019 issues:

1. Personal Care Assistant (PCA) Program – Increased Reimbursements for Increased HHA Wages

GAO is advocating for HHAs like Indira (right) and clients like Jessie

GAO is working in collaboration with other providers and the New Jersey Home Care and Hospice Association to educate our legislators on the importance of adequate funding for the Personal Care Assistant (PCA) program.This is especially important as the State recently mandated an increased minimum wage. BAYADA supports a wage increase for all of our home health aides (HHAs) for the incredible, lifechanging work they do—but additional advocacy is necessary so state legislators understand the importance of proportional PCA program funding so that providers like BAYADA can comply with the new mandate and stay sustainable.

Click here to check out how HHA Indira helps her client Jessie stay at home, and about CHHA Michele’s special bond with her client Marie. We are hopeful that our advocacy efforts can lead to a fairer wage for aides like Indira and Michele, as well as better recruitment and retention rates across the ACSP practice so that all New Jersey residents who need this important service can access it. To find out how you can get involved, email advocacy@bayada.com today.

2. Private Duty Nursing (PDN) Program—Increased Reimbursements for Increased Nursing Wages

Increased PDN rates are important to ensure clients like Lili (left) can continue to have reliable nurses like Barbara (right)

GAO is working with the New Jersey Home Care and Hospice Association to educate our legislators on the importance of adequate funding for the Private Duty Nursing (PDN) program. Current PDN program funding makes it difficult for providers like BAYADA to recruit and retain the nurses necessary to care for New Jersey’s most medically complex and residents. This difficulty results in significant access to care issues, as only 85% of scheduled hours are currently filled, and vulnerable New Jersians are going without the care they need to stay safe and healthy at home.

We are lucky to have home care supporters in the legislature who understand the struggles our caregivers and skilled nursing clients face—Recently, Bill S1733/A4575, which proposes a $10 per hour increase for RN and LPN home care services, was introduced. In addition to the increase, this bill also seeks to establish a “rate floor” so that managed Medicaid providers reimburse no less than the state fee-for-service rate for in-home skilled nursing services.

But we need your help in getting this bill to the finish line. Soon, this bill will be up for a hearing, and clients’ and employees’ testimony make the most impact in showing legislators the challenges that arise from inadequate funding and the associated access-to-care issues.

Click here to read excerpts from two clients’ testimonies regarding the importance of PDN in their lives. Powerful stories like the ones Dana and Emma share help our advocacy efforts and show legislators the impact of home care in making a real difference in vulnerable New Jersey residents’ lives. To find out how you can get involved, email advocacy@bayada.com today.

Home Health Aides Deserve Better Wages! If Done Right, Mandatory Minimum Wage Increases Will Help

Home health aides provide a lifeline to millions of Americans, but low wages make it difficult to recruit and retain enough to keep up with the demand. If done thoughtfully, mandatory minimum wage increases can help support these valuable workers

It’s undisputable: Home health aides provide a lifeline to millions of Americans that need assistance living where they want to be—at home. But low wages often disincentivize home care workers from staying in the field. The problem lies in Medicaid reimbursement rates: Home health aides rely largely on state-determined Medicaid reimbursement rates for their wages, and those rates have stagnated well below the cost of living—and many states have not addressed this in years.

Luckily, many states have proposed increasing the mandatory minimum wage. And while many businesses often oppose such measures—many home care industry leaders have come out in support of it because they recognize the importance of aides in helping keep people at home and earning a fair wage for doing so. But we must ensure that minimum wage increases are done with the recognition that many home care programs rely on state funding to pay their workers. And if that funding isn’t increased in tandem with mandatory minimum wage increases, the state could unintentionally be putting vulnerable residents at risk.

Simply put, if Medicaid reimbursement rates for home care services are not increased at all, or at a rate too low to cover new minimum wage standards, then many home care providers will need to consider whether they can afford to keep their doors open. If providers do decide that they cannot remain sustainable and do decide to forgo providing Medicaid-based home care services, then the real loser is the millions of Americans that rely on that provider to live independently at home. Down the line, this could result in more people who can live at home with help from a home health aide into being forced into nursing homes.  

“People want to live at home. And it’s the most cost-effective option for states. Home health aides are the backbone of our industry and we absolutely support wage increases for our workforce, but states need to be thoughtful in their approach to protect the many seniors and individuals with disabilities that rely on home and community-based services. We are working with state legislatures to make sure that they understand the relationship between rates and wages, and the potential risk to vulnerable residents who need home care,” says BAYADA Chief Government Affairs Officer Dave Totaro.

So far this year, 18 states have started the year with higher minimum wages than the year before. If you live in a state where the minimum wage is set to increase, then you have a unique opportunity to advocate and tell your legislators about the importance of home care and of paying home health aides a living wage. Contact advocacy@bayada.com to find out ways you can play a role in ensuring that home care is accessible to the many that want to stay at home, and that home care workers continue to be attracted to a field that helps them do just that.

Maryland’s 2017 Legislative Session Now Closed

Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)

Wrapping up on April 10, the General Assembly considered 2,876 bills and resolutions over the 90-day session.  Of those, 940 bills and resolutions passed.   I am preparing a full session report but, of note, the bill containing our offices’ ability to accept orders from physicians in neighboring states passed and will become law as soon as Governor Larry Hogan signs it.  The budget passed nearly two weeks before it was due, including a 2% increase in Medicaid home health care reimbursement rate.  A bill mandating paid sick leave statewide passed but is expected to be vetoed.  Finally, three separate efforts to increase the minimum wage to $15 – statewide, in Baltimore City, and in Montgomery County – all failed.  Now the work to prepare for next session begins.

In Pennsylvania, Fundraising Season Abounds

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

Now that the PA House and Senate appropriations hearings have finished, the fundraising season for candidates has begun.  First, Chief Government Affairs Officer Dave Totaro and I had the opportunity to thank Representative Bill Adolph for being our champion.  During the event, we had the opportunity to see Senator Scott Wagner, who is also running for Governor, and Congressmen Pat Meehan.  Next, I had the opportunity to speak with the new House Appropriations Chair Representative Stan Saylor.  We discussed the need for higher reimbursement rates if the state approves a minimum wage increase.  The events were rounded out by a visit with Senator Judy Schwank the Health and Human Services Minority Chair, Representative Donna Bullock, Aging and Youth Chair Senator Michele Brooks, and Representative Madeline Dean.

Supporting our Political Action Committees is an important part of the Government Affairs Office’s recipe for success.  Fundraisers provide additional opportunities to get to know legislators who make decisions about home health care.  It is also a way to ensure those that support home care get into and stay in office.

Mayor Vetoes Higher Minimum Wage in Baltimore City, MD

Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)

The Baltimore City Council voted last Monday to increase the minimum wage in steps to $15 by 2022.  The newly-elected Mayor of Baltimore, former state Senator Catherine Pugh, supported an increased minimum wage during her campaign.  In a surprise change of heart on Friday, March 24, she vetoed the bill citing an unanticipated budget shortfall, schools budget deficit and new costs for police oversight since she took office.  The increase would have cost the city an additional $116 million in wages over the next four years.  City councilmembers do not have the votes to override Pugh’s veto.

Maryland Ambassadors Meet With Legislators And Key Staffers On Business Issues

Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)

Five ambassadors and I went to Annapolis on Wednesday to discuss business issues that could have a big impact on our practice. Increasing the minimum wage and mandating paid sick leave are hotly debated issues in this session. Baltimore, MD West Home Health (BWV) Area Director David Pareja, Maryland state resident and Delaware Pediatrics (DP) Associate Director Mandy Brady, Harford County Home Health (HFV) Marketing Manager Nicole Matricciani, Baltimore, MD (BAL) assistive care Associate Director Matt Paske, and DP Intern Tiffany Francis met with 18 legislators and key staffers on these issues and others, protecting our practice and building our reputation with our legislators.

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BAYADA staff in Annapolis

Pennsylvania House And Senate Appropriations Committees Host Marathon Hearings

Submitted by Laura Ness, Director, PA Government Affairs (GAO)

Last week, the House and Senate Appropriations Committee hosted hearings for the Department of Human Services (DHS), the Department of Aging, the Department of Health, and the Department of Drug and Alcohol Programs. This was an opportunity for the various secretaries to defend the Governor’s proposed 2017-2018 budget.

Each hearing lasted for five hours and covered a variety of subjects.  Much of the discussion centered around the value of home care and Governor Tom Wolf’s proposal to increase the state’s minimum wage to $12 per hour. During the hearing, DHS Secretary Ted Dallas acknowledged if the minimum wage is increased, the state will also need to increase reimbursement rates. Secretary Dallas claims a $12 minimum wage would lift 145,000 Pennsylvanians out of poverty and off of assistance. The secretary has calculated that it would save the state $48 million in DHS spending.

Debates Heating Up In Baltimore City, MD

Submitted by Shannon Gahs, Associate Director, MD Government Affairs (GAO)

Debate over mandating employer-paid sick leave statewide and an increased minimum wage for Baltimore City is heating up this week.  Both are expected to pass.  By the end of last week, the Maryland Senate and the House both reached their thousandth bill introduced since the 2017 session opened in mid-January.  Bills must be fully approved by both chambers before the last day of session, which is April 10 this year, or start anew in the following year in the state’s condensed legislative calendar.