Raimondo Reverses Course on Investing in Home Care at Peril to RI - Oliver & Ellison

Thursday, February 01, 2018

Guest MINDSETTERS™ Laurie Ellison, RN, BSN & Nicholas Oliver, MPA, CAE

Gina Raimondo

Governor Raimondo has abandoned her promise through her “Reinventing Medicaid” initiative to improve the wages of those that deliver high-quality healthcare in the homes of Rhode Islanders.

The last reimbursement rate increase for home care nurses was seventeen years ago in the state fiscal year 2002. While most Rhode Islanders have seen several pay increases during that time span, Governor Raimondo continues to expect that our nurses and therapists earn the same wage as they did on October 1, 2001.

Her recent budget proposal for the next fiscal year does nothing to improve the inadequate funding to support home and community-based healthcare services and rebalance taxpayer-supported long-term care financing. Home care agencies cannot compete in the labor market and agencies are closing as a result. In the last year alone, we have seen longstanding home care agencies close, such as HealthTouch, Homefront Health Care and the VNA of Rhode Island, due to this administration’s inaction. Now, the Governor is proposing to redesign the potentially cost-saving managed care program called the Integrated Care Initiative that was initiated in 2013 in which provided Medicaid-contracted home care providers with a slight increase in reimbursement rates to which made it easier to compete in the labor market to fill cases. Home care, home health, and hospice agencies cannot afford for this program to be taken away from our Medicaid patients and clients.

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Each legislative session, our association advocates for increased reimbursement funding for healthcare services rendered to our state’s homebound population. Many of our patients and clients are disabled without the ability of multiple functions of independent daily living, such as the ability to feed themselves, bathe, use the toilet or conduct their regular household chores. Some of our patients and clients require skilled nursing and therapeutic services in order to maintain their limited health condition at home and avoid hospitalization or residing in a nursing home. Our patients and clients are of all ages as we care for infants and children with exceptional disabilities and adults and elders with chronic and terminal illnesses and disabilities.

Our home care, home health, and hospice services are vital to allow over 20,000 Rhode Islanders to live independently with supports to remain with their families at home and in their communities. Plus, because our healthcare services are less expensive than hospitalization or the costly room and board fees associated with nursing homes and assisted living facilities, home care saves significant funding for our state’s healthcare system, including state-funded programs such as Medicaid, and commercial health insurance programs such as what many working Rhode Islanders have through their employer.

Medicaid reimbursement rates are the minimum rates in which home care providers can charge by law for their services. Our rates for our other payor sources, such as commercial health insurance, long-term care insurance, workers compensation insurance and private pay are based on Medicaid rates and tend not to be significantly higher than those set by Medicaid. As a result of these highly-regulated rates, once we pay for medical equipment and supplies, office expenses, professional liability and employee-related expenses, such as workers compensation insurance and travel expenses, we are limited to paying our nurse assistants just above the minimum wage and our nurses over ten dollars an hour less than nursing homes and hospitals based on their reimbursement rates and annual cost-of-living adjustments, despite serving the same population.

For the past two years, Governor Raimondo has proposed slight increases to the reimbursement rates for services rendered by our nurse assistants. These proposals have been adopted by the General Assembly in the last two annual budgets. However, these increases were required only by the fact that the state’s recent minimum wage increases would have kept home care nurse assistant wages under the new minimum wage. This has done nothing to “move the needle” to improve our industry’s business climate here in Rhode Island.

Now, under this current budget proposal, in which the administration intends to move away from managed care reimbursement rates, home care agencies must revert on average over half of their Medicaid patients and clients back to the fee-for-service system with the state’s Medicaid program at an average seven-percent cut. If the General Assembly were to adopt the Governor’s plan to redesign the Integrated Care Initiative, taxpayers may lose out on the cost-savings to manage this population, beneficiaries may lose their access to home care services and home care wages will become out of compliance with the minimum wage.

If Governor Raimondo and her administration, along with the leadership of the General Assembly, want to save taxpayers’ money by rebalancing our long-term care financing system away from expensive facility-based care and room and board costs and toward home and community-based healthcare services to manage Rhode Island’s population with significant healthcare needs, home care needs a stronger investment to remain competitive in the labor market, the resources to care for all Rhode Islanders in need of our services and the ability to comply with minimum wage laws and the new paid sick and safe leave law. Without a funding increase this session, we will see more home care agencies close and a continuance of the access crisis.

Raimondo Reverses Course on Investing in Home Care at Peril to RI - Oliver & Ellison

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