Numerous states are raising Medicaid payment rates for home healthcare amid a workforce shortage, with some also enhancing worker training and education. Most states reported staffing gaps in various healthcare roles. Concerns about the burden on healthcare facilities, particularly in rural areas, have been raised regarding new federal staffing requirements for nursing homes, suggesting potential increases in care challenges if these requirements are implemented.
As the healthcare workforce shortage intensifies, several states are taking proactive steps to address the issue. Many of them are increasing Medicaid payment rates for home healthcare services and bolstering worker training and education programs. Widespread staffing gaps across various healthcare roles have raised concerns, especially for healthcare facilities in rural areas. Additionally, the potential implementation of new federal staffing requirements for nursing homes has sparked worries about added strain on healthcare providers, potentially exacerbating care challenges.
Amid workforce shortages in the home healthcare sector, numerous states are elevating Medicaid payment rates. This move is supplemented by enhanced training and educational initiatives for workers in this field.
According to a KFF issue brief, the increase in Medicaid reimbursement for home healthcare services comes as the sector faces significant staffing challenges. These challenges were intensified by the COVID-19 pandemic, particularly affecting Medicaid-supported home and community-based services (HCBS), which encompass home health, personal care, and specialized services for groups like individuals with disabilities.
A survey conducted between May and August 2023 by state officials overseeing Medicaid HCBS programs showed measures taken by states to mitigate HCBS workforce shortages, particularly as certain pandemic-related flexibilities concluded.
Excluding Florida, all states participated in the survey, though responses varied across different questions.
Workforce deficits in 2023 were universally reported by responding states, including Washington, DC. Shortages were most acutely felt in positions such as direct support professionals (50 states), personal care attendants (49 states), and nursing staff (49 states), along with gaps in home health aides (47 states), case managers (45 states), community-based mental health workers (38 states), and various therapy providers (35 states).
These shortages stem from factors like inadequate reimbursement rates and rigorous demands on providers. HCBS providers, in 2021 focus group discussions, described their roles as physically and mentally taxing.
Due to these challenges, numerous states experienced closures in HCBS facilities such as adult day programs, group homes, and assisted living centers. Over half of the states (37) indicated that multiple provider types faced closures, driven by staff shortages and pandemic impacts.
To combat these shortages, most states (48) have increased payment rates for providers. While some have made these increases permanent, 13 states indicated that the hikes were temporary for certain staff categories. Notably, only 14 states have indexed their payment rates to the cost of living, and this indexation doesn’t apply uniformly across all staff types.
Moreover, 42 states are developing or enlarging education and training programs for workers, with 41 states offering incentives for recruitment or retention.
Additional strategies include raising state minimum wages (20 states) and providing paid sick leave (19 states). Other measures focus on connecting job seekers with employers, outreach to potential employees, and leveraging social media for recruitment.
Payment rate analysis among the 34 states that base rates on time shows that 20 states pay less than $20 per hour. The average rates stood at $19 per hour for personal care providers, $28 for home health aides, and $43 for registered nurses in home and community-based care.
The broader long-term services and supports (LTSS) sector, including nursing facilities, has also faced significant workforce issues since the onset of the pandemic.
A rule proposed by the Biden Administration, aiming to set minimum staffing requirements in nursing homes, has raised concerns. Congressman Greg Pence (R-IN), among others, cautioned that this rule might further strain nursing homes struggling with staffing and financial challenges, potentially denying necessary care to seniors, especially in rural areas. Pence urges a reconsideration of this one-size-fits-all approach, highlighting its potentially adverse consequences.
