More than half of the states have increased payment rates for Medicaid home- and community-based services to address workforce challenges after assisted living communities closed, according to new data from KFF.
In an issue brief issued Tuesday highlighting states’ ongoing strategies to respond to workforce challenges and how they pay HCBS workers, KFF said that all surveyed states that are experiencing shortages of direct care workers, personal care attendants, nursing staff and home health aids reported HCBS provider closures. Those closures were most common among assisted living communities (27 states), group homes (29 states) and adult day programs (32 states).
The American Rescue Plan Act helped states enact new policies to address some shortfalls, but many of those policies are ending and federal funding will expire, leaving states to look for alternative funding sources to maintain spending levels, KFF said.
Forty-eight states reported that they increased Medicaid HCBS rates to recruit and retain workers, whereas 42 states said that they had developed or expanded education and training programs, and 41 states said they offered incentive payments.
Less common initiatives included establishing or raising the state minimum wage (20 states) or offering paid sick leave (19 states). Other workforce initiatives included creating platforms or support systems to connect job-seekers with employers and positions, launching a social media campaign, and providing outreach to prospective employees.
If the HCBS access rule is finalized, states would be required to demonstrate that at least 80% of Medicaid HCBS payments went to direct care workers and to demonstrate that payment rates are adequate to ensure a sufficient direct care workforce.
Looking at the future of the Medicaid HCBS workforce, the Peterson-KFF Health System Tracker showed that as of June, the number of workers in LTSS settings was lower than in early 2020 — the result of demanding working conditions and low wages, KFF said.
HCBS provider payment rates vary considerably, but KFF estimated that median hourly payment rates are $19 for personal care providers, $28 for home health aides and $43 for registered nurses.
