Wisconsin set to get a lot of help for Home Care. If WisGOPs don't sabotage it

The GOP-run Joint Finance Committee (JFC) is already set to consider whether they should modify or tank the hundreds of millions of new federal highway funds that’ll be coming our way as a result of recent action in Congress (which I discussed in this post). And you should certainly stay aware of that as 2021 winds down.

But JFC is also looking at another set of Biden/Dem funds from DC – this one involving a 5% increase in pay rates for providers of home-and-community-based medical services. Here’s the request by the Department of Health Services, which explains that no additional state tax dollars are needed under the plan.

The annualized cost of the rate increase is $156.3 million All Funds, which will be funded with enhanced funding for Medicaid HCBS provided through the federal American Rescue Plan Act of 2021 (ARPA). As a result, the rate increase will be GPR neutral to the Medicaid budget in the 2021-23 biennium.

Let me quickly backtrack and explain why Joint Finance has any role in this in the first place.

The department may not submit a Medical Assistance state plan amendment to the federal department of health and human services or implement a change to the reimbursement rate for or make a supplemental payment to a provider under the Medical Assistance program under this subchapter when the amendment, rate change, or payment has an expected fiscal effect of $7,500,000 or more from all revenue sources over a 12-month period following the implementation date of the amendment, rate change, or payment without submitting the proposed state plan amendment, rate change, or payment to the joint committee on finance for review. If the cochairpersons of the joint committee on finance do not notify the department within 14 working days after the date of the submittal under this paragraph that the committee has scheduled a meeting for the purpose of reviewing the proposed state plan amendment, rate change, or payment, the department may submit the state plan amendment, implement the rate change, or make the payment.

So this $156.3 million boost in Federal help and added services triggers this requirement. And as DHS notes, it’ll happen because the Feds are picking up more of the tab for these services.

The federal ARPA legislation enables state Medicaid programs to claim an extra 10 percentage points of federal Medicaid match on eligible HCBS for claims paid for April 1, 2021 through March 31, 2022. As a condition of receiving the funds, the state must reinvest an equivalent amount in a plan to enhance, expand and strengthen Medicaid HCBS. The state has until March 31, 2024 to spend the reinvestment funds, and it can draw additional federal funding for reinvestments in Medicaid-eligible activities.

The Centers for Medicare and Medicaid Services approved Wisconsin’s reinvestment plan on September 3, 2021. Under the plan, the Department expects to claim an estimated $353.2 million in enhanced federal matching funds for current HCBS expenditures. When combined with an additional $346.5 million in federal funds claimed for Medicaid eligible activities, the reinvestment plan totals $700.7 million All Funds. This rate increase would comprise approximately 50 percent of the required reinvestment under the approved plan and would have no GPR cost impact on the Medicaid program through March 2024.

Of course, the GOPs in the gerrymandered Legislature have previously turned down “free Federal money to pay for things we already do, allow us do more” (see Medicaid expansion for the last 8 years). So we need to keep our eyes on the GOP-run Joint Finance Committee, and see that they don’t take steps to keep these extra ARPA funds from being sent out, or not allowing this boost in HCBS rates paid to caregivers and providers. Especially in the 11 months before an election.

Of course, the GOP Legislature hasn’t had a problem taking expanded Federal coverage of costs for pretty much anything else, including COVID relief packages, so maybe because it doesn’t have the name “Obamacare” associated with it, they’ll be fine with it (yes, I know that’s pathetic and hypocritical. But that’s WisGOP).

One group that is already asking the JFC to OK the rate increase and added federal funding is Disability Rights Wisconsin, who says that rates need to be raised to keep staff and maintain services to vulnerable Wisconsinites.

As the Protection and Advocacy system for people with disabilities in Wisconsin, we are uniquely positioned to see how the COVID pandemic has exacerbated what was already a critical shortage of workers willing to care for our most vulnerable citizens. The Department of Health Services has been working closely with advocates, including DRW, and the Long-Term Care Advisory Council to identify issues created by the workforce shortage and the impact on people with disabilities. DRW has been providing information about the many concerns we are seeing. The 5% rate increase DHS is proposing will certainly help address this exceedingly acute crisis…..

DRW’s Family Care and IRIS Ombudsman Program has seen a significant increase in calls related to the caregiver crisis. This lack of caregivers impacts all parts of caregiving in the longterm care system, including residential settings, day programs, employment supports, transportation, respite and self-directed supports. Lack of available staff has led to facility closures, limited supportive home care hours, waitlists and increasing rates of no-shows. Residential relocation cases are taking longer to resolve and the choices offered people are often geographically distant from their friends, families, and community connections. Providers with dubious health and safety records continue to come up as “options” when MCOs are desperately trying to place someone who needs to be discharged from a hospital or nursing home stay. At the core, the intractable problem is that there are simply not enough workers to provide care that has already been authorized.

Under other circumstances we might be suggesting that a serious vulnerability in the community-based care system exists that will result in many people being forced into nursing homes even though their needs could be met at home or in smaller, less expensive, and more homelike settings. But nursing homes are facing similar staff shortages and are not readily available, even as a last resort. We must increase our efforts to preserve the community-based system not just because it is what most people want and the right thing to do, but because there is no viable alternative to it, even on a temporary basis.

The workforce we draw from to fill these caregiving jobs, though largely unskilled or semiskilled, is in high demand at present and for the foreseeable future. A difference of 5% in the wage may make the difference between those workers deciding to stay in the caregiving trade or moving on to something that is probably easier to do and more lucrative. Simply put, workers need money to pay rent and feed their families. Even committed and caring workers will gravitate away from jobs that cannot support those basic needs.

The Build Back Better bill would also add to services that disproportionately help the disabled, through extra federal Medicaid funds for Home and Community Based Services (HCBS), and additional incentives and other assistance for states to expand their offerings for services to take place outside of nursing homes.

While some groups don't get the media attention that screeching RW nutjobs at school boards do, several organizations have been in DC and other places asking for this expansion of HCBS in BBB for several months.

Care workers are so close to having better wages and the ability to take care of themselves and their family.

They need the Senate to deliver for them, there’s too much at stake not to. #CareCantWait https://t.co/Vu72XTJokz

— Domestic Workers (@domesticworkers) November 23, 2021

And those Build Back Better funds come through “regular” Medicaid, and don’t even require the gerrymandered WisGOP Legislature to expand all of Medicaid to take the money (although they’d get MORE money to cover the costs if they did). So if expanded HCBS is part of whatever becomes law from Build Back Better, that’s a win-win.

But that hasn’t happened yet, and so we need these expanded ARPA funds in the meantime. And let the GOPs on Joint Finance know we are watching them to make sure they don’t mess this up, which would put a lot of vulnerable Wisconsinites at unnecessary risk and stress.