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Less common initiatives included establishing or raising the state minimum wage 20 states and offering paid sick leave for workers 19 states. States also reported several other types of initiatives to strengthen the workforce, including creating platforms or support systems to connect job seekers with employers and positions, launching a social media campaign, and providing outreach to prospective employees.

Some states have permanent payment rate increases in place for providers, but 13 states reported that payment rate increases for at least some of the workers were temporary.

Only 14 states have payment formulas that automatically increase with the costs of living, but those formulas do not apply across all types of workers. KFF asked states to report their average dollar rate per visit paid to two types of HCBS provider agencies personal care agencies and home health agencies and three types of specific HCBS providers personal care providers, home health aides, and registered nurses , but many states were unable to report all rates Figure 5, Appendix Table 5.

The number of states that did not provide payment rates or reported that payment rates were unknown was 8 for personal care agencies and 24 for home health agencies.

Even more states did not provide payment rates for specific provider types: For each specific type of provider, nearly half of states did not provide payment rate information or reported that payment rates were unknown. If provisions of a proposed Biden Administration rule are finalized, states would be required to report such detailed payment rates see Box 2.

Among the states that were able to report payment rates, only 15 could report payment rates for personal care agencies, home health agencies, personal care providers, and home health aides, all of which would be required under the rule. Those 15 states include states that reported a mix of time-based and visit-based rates, which makes comparisons between provider and agency rates more complicated.

Given the challenges for states in collecting such data, federal guidance might be required to achieve consistent reporting across states. On May 3, , the Biden Administration released a proposed rule aimed at ensuring access to Medicaid services, which has several notable provisions aimed at addressing HCBS workforce challenges.

States would be required to report payment rates for personal care, home health aide, and homemaker services to increase transparency around payment rates.

For services provided through c waivers and through the state plan authorities, the proposed rule has additional requirements related to the HCBS workforce, including the following.

The proposed rule also includes provisions that would strengthen requirements around person-centered planning and needs assessment, create new requirements around incident management, establish requirements for people to file grievances if they are receiving HCBS from the state Medicaid program, and require states to report on nationally-standardized quality measures.

Provisions would take effect on a rolling basis, between 2 and 4 years after the rule is finalized. States reported many reasons why it was difficult to report payment rates, including the following.

In addition to having difficulty reporting payment rates, many states reported different payment rates for personal care across different waivers and the waiver payment rates often differ from the payment rates for personal care provided through the state plan.

When states reported multiple payment rates for personal care, KFF used the median of those payment rates in the analysis.

Although KFF asked states to report the average dollar rate per visit, states varied in their reporting of payment rates, with most states reporting payment rates by time either 15 minutes or one hour , and a smaller number of states reporting rates that were per visit or per day.

Rates for home health aides are somewhat higher, reflecting the additional training requirements for such workers. Among the states with payment rates in the highest category, some reported that the rates were per visit or per day. Others did not indicate whether their rates were based on time or another basis, but it is likely that most payment rates in the highest category are per visit or per day.

Payment rates to home health agencies are generally larger than those to personal care agencies, but there is considerable variation in both Figure 6.

The payment rates to HCBS providers also show considerable variation and are somewhat higher than those reported by other organizations on account of differences in reporting and provider categorization Figure 6. It is difficult to compare those numbers to those of other organizations for the following reasons.

Among states that deliver HCBS through managed care , 20 states reported that the fee-for-service payment rate is the minimum amount MCOs could pay providers. Out of the 36 states that use managed care to provide at least some HCBS, none of the states reported that fee-for-service rates were the maximum amount that managed care plans could pay providers.

There were 20 states that reported fee-for-service rates were the minimum payment rates, 12 states that reported there was no relationship between the fee-for-service and managed care rates, and 4 states that reported the answer was unknown or did not respond to the question.

Even among states that do not directly tie fee-for-service rates to managed care rates, the fee-for-service rates may affect negotiations between health plans and HCBS providers, thereby, affecting the managed care rates.

Furthermore, it is common for provider reimbursement contracts that are directly tied to the Medicaid fee schedule i. How does the workforce shortage for Medicaid HCBS fit in with the broader staffing challenges for long-term services and supports LTSS?

Recent analysis on the Peterson-KFF Health System Tracker shows that, as of June , the number of workers in LTSS settings was measurably lower than in early Kleenex Ultra Soft 3-Ply Facial Tissue.

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Plus, many provide transportation to assist those who need reliable transportation. Breaking up in-home care with adult day services a few days a week ensures that seniors receive full-time support without paying as much. But when used with other means, such as tax credits, community services, or adult day care, respite care could allow older adults to continue aging in place instead of moving to a facility.

Yet, the cost is one of many factors preventing seniors from receiving home care. Fortunately, numerous resources are available to help lower the cost of in-home care for elderly adults.

MeetCaregivers connects seniors and highly-qualified caregivers and companions who help with ADLs, IADls, companionship, and more. We utilize several unique proprietary tools designed to transform the in-home care experience:.

Call 1 to chat with a care coordinator or find a caregiver today. Visit our Blog for similar articles about aging in place, caregiving, and more.

Madison January 15, Are There Programs To Lower The Cost Of In-Home Care For Elderly Adults? In-home care supports this choice and prolongs independence by assisting with various activities such as: Personal care Light housekeeping Transportation assistance Grocery shopping, and more.

State Medicaid Programs. Older Americans Act OAA. These benefits can help offset various costs of in-home care for elderly adults, such as: Housework Meal delivery Personal care Home health care Shopping services Transportation assistance. Certain types of in-home therapies are available under Medicaid in some states.

National Council on Aging NCOA BenefitsCheckUp. State Health Insurance Assistance Programs SHIP.

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10 Free \u0026 Low-Cost Health Care Services - Medicaid Updates 2023

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