In-home care agency leaders say the leading state budget proposal to raise some of Pennsylvania's Medicaid reimbursement rates will not adequately address the industry's ongoing wage and staffing crisis.
Health care workers have long said the commonwealth's Medicaid reimbursement rate for caregivers — $20.63 per hour — is too low compared to its neighbors, including Ohio's $28.96 per hour, Maryland's $25.58 and West Virginia's $25.44.
Organizers of the Pennsylvania Homecare Association argue the state's insufficient rate has caused employee wages to stagnate, driving caregivers to leave the industry. The organization has found more than 100,000 in-home shifts statewide go unfilled per month.
The Homecare Association's members last week sent letters to some top lawmakers' offices, urging them to increase the Medicaid reimbursement rate as part of this year's state budget.
Members of the organization hand-delivered a letter to Senate Appropriations Chair Scott Martin, R-Lancaster, during a senior expo he hosted in his district last week.
"The people who do this work often live in the very neighborhoods we serve," the letter reads. "They are providing intimate, essential care to help our most vulnerable neighbors live with dignity, but Pennsylvania's payment rates often aren't enough for them to pay their own bills. Without action in this budget, more caregivers will leave the profession, and more families will be left to fend for themselves."
Martin's office did not respond to a request for comment.
Similar letters were sent to House Appropriations Chair Jordan Harris, D-Philadelphia; Senate President Pro Tempore Kim Ward, R-Westmoreland; and Senate Majority Leader Joe Pittman, R-Indiana.
Gov. Josh Shapiro's proposed budget includes an additional $21 million, or a 10% raise, to increase reimbursement rates for workers hired directly by patients. Those funds remain on the line as lawmakers negotiate the state budget behind closed doors.
Senate Republicans have repeatedly said they want to cut spending allocated to programs under the Department of Human Services.
And according to the Homecare Association, Shapiro's proposal is even insufficient. Only 6% of in-home care patients hire caregivers through the nonagency model, the organization argues, while the remaining 94% hire caregivers through an agency.
Agencies would not receive any increases to their Medicaid reimbursement rate for caregivers under either of the budgets proposed by Shapiro or House Democrats.
"Agencies like ours want nothing more than to pay caregivers more," the letter to lawmakers says. "We've cut costs in every way possible to prioritize wages — streamlining operations, reducing administrative overhead, and doing everything we can to stretch each dollar."
"Without a meaningful increase in the reimbursement rate, we cannot stabilize the workforce or grow it to meet rising demand," it says.
The industry's staffing shortage puts care at risk for the more than 400,000 Pennsylvanians who rely on in-home care, according to the Homecare Association, including seniors and people with disabilities.
Pittman told abc27 Sunday that lawmakers "still have a ways to go" to reach an agreement on the budget. His spokeswoman did not answer questions in an email on Monday about the Medicaid reimbursement rate.
'Tough budget year'
Cody Jones, senior director of government affairs at the Pennsylvania Homecare Association, said his organization is seeking $370 million from the state to increase all caregiver wages by 10%, including agency and nonagency workers.
Jones said the Shapiro administration and many top Democrats and Republicans all have similar responses when asked to raise the Medical reimbursement rate: "'It's a tough budget year.'"
Jones said their actions largely ignore the ongoing staffing and wage crisis impacting Pennsylvania, which Shapiro's administration has previously acknowledged.
In February, the Department of Human Services released a study that recommended the state invest more than $800 million in additional funding to raise the state's Medicaid reimbursement rate to $25.42 per hour.
SEIU Healthcare represents the some 8,500 direct-care workers who stand to receive a bonus under Shapiro's proposal. Those workers, some of the lowest paid in the industry, are celebrating Shapiro's proposed $21 million as a first step toward supporting direct patient care models, according to Spotlight PA.
"While we know that $21 million alone will not solve Pennsylvania's home care crisis, we see Governor Shapiro's proposal as a critical down payment that supports participants who self-direct their care and their caregivers who too often lack basics like paid time off," SEIU President Matt Yarnell told WITF in a statement, adding that the amount could qualify the state for an additional $27 million in matching federal funds.
Yarnell said SEIU agrees with the Pennsylvania Homecare Association "that Harrisburg must go further to raise wages and strengthen care across the industry." He also noted his organization's backing of legislation to increase accountability for in-home care agencies.
The lawmakers who last year introduced the bipartisan bill — Reps. Jessica Benham, D-Allegheny, and Jason Ortitay, R-Washington — said in their memo seeking support from lawmakers that caregivers make only about $13 per hour of the $20 per hour that agencies receive through Medicaid reimbursement.
"This means that most agencies only spend about 65% of their public funding on care, which is wasteful and unethical," Benham and Ortitay wrote.
Jones said agency caregivers in Pennsylvania make about $16 an hour.