On Wednesday, Nevada moved a step closer to creating a home care standards board that the Personal Care Association of Nevada (PCAN) fears could put undue burden on the state’s home care industry.

Nevada’s Senate Finance Committee approved SB 340  — known as the Nevada Home Care Workforce Safety and Standards Act. The proposal calls for a standards board to investigate home care agencies, adopt regulations and make recommendations regarding the minimum wage.

But PCAN President Robert Crockett told McKnight’s Home Care Daily he worries that creating a board with authority over worker wages — but not over Medicaid reimbursement rates — could be financially devastating to home care firms.

Robert Crockett

“If you’re going to give the director of Health and Human Services the authority to increase wages, then give him the authority to direct a rate increase to (the Centers for Medicare and Medicaid Services). That’s all I’m asking for. That it’s fair,” Crockett said.

Service Employees International Union (SEIU) is pressing for a standards board as Nevada struggles to meet growing demand for workers to care for its aging population. SEIU Local 1107 recently told McKnight’s Home Care Daily  the board would give care workers “a seat at the table” regarding wages and benefits.

Narrowing gap

But In Nevada, home care agencies are struggling with a narrowing gap between the minimum wage and the Medicaid reimbursement rate. The average hourly wage for personal care workers is $11.09, while the Medicaid reimbursement rate is $16.52 — the lowest level in nearly 20 years. A pandemic-related budget crisis last summer forced the state to cut the reimbursement rate by more than a dollar.

Crockett said taxes and personal protective equipment costs have increased, making it hard for providers to turn a profit. He said if the hourly wage for workers increases, but the Medicaid reimbursement rate doesn’t, agency owners might have to trim retirement programs, medical insurance and other benefits.

“I don’t want those programs to go away because I got squeezed. Those are good for my people, but those add costs too,” said Crocket.

Focus on rates 

Recently, home care agencies across the U.S. have been shining a spotlight on Medicaid reimbursement rates as Congress debates President Joseph Biden’s $400 billion plan to beef up the nation’s care industry. In a webinar earlier this week, members of LeadingAge — which represents 5,000 nonprofit aging service agencies — said a higher minimum wage for care workers must also include higher Medicaid reimbursement rates for providers.

Crockett said he favors paying care workers an hourly rate of $15, but only if the Medicaid reimbursement rate is increased above $20.

“Touching Medicaid reimbursement takes a lot of courage because it’s like an annuity. You’re paying millions of millions of extra dollars every year for the future once you raise the rates. (The state) can say raise personal care aides wages and it doesn’t cost a penny. That just pushes the problem on me,” said Crocket.

The Nevada Home Care Workforce Safety and Standards Act is now headed to the full Nevada Senate for approval. From there, the legislation will proceed to the state assembly.