Federal officials are revising the rules regulating Medicaid home and community-based services for disabled people to enhance access and expand the direct support professional workforce.
The Centers for Medicare and Medicaid Services issued a final rule this week that establishes minimum payment criteria for direct care providers, requires states to reevaluate the needs of people receiving home and community-based services regularly, and much more.
The Centers for Medicare and Medicaid Services said the rules attempted to address large discrepancies in quality and reporting requirements among states. The rules are also intended to address a nationwide shortage of direct care workers.
One of the critical reasons for the shortage is low wages. The average hourly wage for a direct care worker in 2022 was just $15.43. In the lowest-paying states, which include Louisiana, West Virginia, Texas, Mississippi, and Oklahoma, home healthcare workers often earn less than $12 per hour. Even in the highest-paying states, which include Massachusetts, North Dakota, Alaska, Washington state, and Colorado, average hourly wages are less than $18.00 as of 2022.
The regulation specifies that states must examine the requirements of each individual receiving home and community-based services once a year and adjust their service plan accordingly. In addition, states must maintain an electronic incident management system and respond to incidents within specific deadlines.
They will also need to establish a grievance process so that beneficiaries in traditional Medicaid plans can file complaints against a provider or the state if they cannot receive home and community-based services. This is similar to the process currently implemented for those with managed care plans.
With few exceptions, at least 80% of Medicaid funds for homemaker, home health aide, and personal care services must be used to pay direct care workers instead of administrative costs. States must provide the average hourly rate paid to workers for these services. Additionally, states must report on a standard set of quality measures, how they build and maintain waiting lists, and the timeliness of service delivery.
The new regulation will go into effect 60 days after it is published in the Federal Register, but states will have years to meet many requirements.
Medicaid’s home and community-based services allow disabled people to live at home instead of in an institutional setting. Medicaid is a lifeline for so many people and must be expanded to accommodate all Americans who need help. Without help, people are often forced into unsafe environments, and this can have devastating consequences.
Sources:
Diament, Michelle. “Feds Finalize New Rules for Medicaid Home and Community-Based Services.” Disability Scoop, Disability Scoop, 25 Apr. 2024, http://www.disabilityscoop.com/2024/04/25/feds-finalize-new-rules-for-medicaid-home-and-community-based-services/30849/.
PHI. “Workforce Data Center.” Last modified September 2023. https://phinational.org/policy-research/workforce-data-center/.
Robertson, Cassandra, et al. “All States Must Set Higher Wage Benchmarks for Home Health Care Workers.” The Economic Policy Institute, The Economic Policy Institute, 2 June 2022, http://www.epi.org/publication/state-home-health-care-wages/.