Guest MINDSETTER™ Casimiro: It’s Time to End the Home Care Access Crisis
Friday, May 12, 2017
During my visit, I met with the proprietor of the home care company from which this constituent utilizes for care, Mary Benway of Community Care Nurses, also based in North Kingstown. Mary provided me with significant information about the plight of home care companies operating in Rhode Island. From low Medicaid reimbursement rates to more stringent business regulations that do not impact delivery of quality care, Mary spoke about some of the home care companies around Rhode Island that have already closed as a result of an unfriendly business climate for these healthcare providers. In fact, the base reimbursement rate in Rhode Island for these services is approximately 28.5 percent less than neighboring Massachusetts and Connecticut. Not only are these companies struggling to survive to care for their patients and clients, the reimbursement rates directly reflect low wages for their direct care staff.
At this visit, I met one of Mary’s employees, a young woman named Krystal, a nurse assistant that delivers personal care services. Some of the tasks in which Krystal provides are assistance with feeding, bathing, toileting, as well as repositioning for her bed bound client. However, Krystal will soon be leaving this client as she will graduate from nursing school in a few weeks and has already sought higher-paying employment at Kent Hospital. Mary considers Krystal a success story as Krystal chose to move up in the healthcare field, instead of how many nurse assistants leave home care, moving to better paying non-skilled jobs, such as within the retail and fast food industries. Because there are more direct care staff leaving the home care industry than those entering into the workforce, there are not enough people to care for the growing list of those without services that are at-risk for hospitalization or nursing home placement that could otherwise be attended to safely at home. This growing list of need has only become exacerbated by the state’s UHIP implementation failure in which providers like Community Care Nurses have experienced significant delays in reimbursement, delayed access to new case referrals, and delayed Medicaid reauthorizations to continue care for some of their clients.
I am fighting to end our state’s access to home care crisis. As a state representative, I am deeply concerned about not having an adequate workforce committed to delivering quality home care. As “baby boomers” age, we will need more nurse assistants, physical therapists, occupational therapists, social workers, and nurses to help navigate our complex healthcare system and deliver healthcare at home, where many of us prefer to live. We cannot lose these vital professionals and paraprofessionals to other industries because their wages do not reflect their value or our need. At the State House, I intend to fight for better reimbursement rates competitive to our neighboring states so that home care companies can remain open and that home care workers in North Kingstown and throughout our state will have the wages that they need in order to remain in home care, receive the same access to quality healthcare that they deliver in our communities, and be able to live comfortably while providing for their families.
Rep. Julie A. Casimiro represents District 31 in North Kingstown and Exeter
Related Slideshow: Winners and Losers in Raimondo’s FY18 Budget Proposal
Criminal Justice Reform
Per recommendations from the Justice Reinvestment Working Group, the Governor is proposing nearly $1 million in investments such as the public defender mental health program ($185,000), improved mental health services at the ACI ($410,000), recovery housing ($200,000) and domestic violence intervention, in her FY18 budget.
English Language Learners
Under the heading of “promoting 3rd grade reading,” Raimondo proposed adding $2.5 million to make English Language Learning (ELL) K-12 funding permanent. The Governor’s office points out that RI is one of four states that doesn’t have permanent funding.
The suggestion was one made by the Funding Formula Working Group in January 2016, who said that “in the event that Rhode Island chooses to make an additional investment in ELLs, the funding should be calculated to be responsive to the number of ELLs in the system and based on reliable data, and include reasonable restrictions to ensure that the money is used to benefit ELLs — and promote the appropriate exiting of ELL students from services.”
Car Owners - and Drivers
Governor Raimondo wants to reduce assessed motor vehicle values by 30% - a change that would reduce total car tax bills by about $58 million in calendar year 2018. Speaker of the House Nicholas Mattiello, however, has indicated that he might want to go further in its repeal.
In her budget proposal, Raimondo also put forth adding 8 staffers to the the Department of Motor Vehicles to "address wait times."
The “Air Services Development Fund” would get an influx of $500,000 to “provide incentives to airlines interested in launching new routes or increasing service to T.F. Green Airport.” The Commerce Corporation set the criteria at the end of 2016 for how to grant money through the new (at the time $1.5 million fund).
Also getting a shot in the arm is the I-195 development fund, which would receive $10.1 million from debt-service savings to “resupply” the Fund to “catalyze development & attract anchor employers.”
Minimum Wage Increase
An increase in the state minimum wage is part of Raimondo’s proposal, which would see it go from $9.60 an hour to $10.50 an hour. Raimondo was unsuccessful in her effort in 2016 to bring it up to $10.10 — it was June 2015 that she signed legislation into law that last raised Rhode Island’s minimum wage, from $9 to 9.60.
The state's minimum hourly wage has gone up from $6.75 in January 2004 to $7.75 in 2013, $8 in 2014, and $9 on Jan. 1, 2015. Business groups such as the National Federation of Independent Business however have historically been against such measures, citing a hamper on job creation.
Like the minimum wage, Raimondo is looking for an increase - in this instance, the cigarette tax, and revenue to state coffers. Raimondo was unsuccessful in her effort to go from a tax of $3.75 to $4 last year. Now she is looking for an increase to $4.25 per pack, which the administration says would equate to $8.7 million in general revenue — and go in part towards outdoor recreation and smoking cessation programs.
The National Federation of Independent Business and other trade groups have historically been against such an increase, saying it will hurt small businesses - i.e. convenience stores. And clearly, if you’re a smoker, you’re likely to place this squarely in the loser category instead.
As often happens in the state budget, winner one year, loser the next. As GoLocal reported in 2016, “the Rhode Island Hospital Association immediately lauded the budget following its introduction, and addressed that while it is facing some reductions, that it "applauds" this years budget after landing on the "loser" list last year.”
This year, it falls back on the loser list, with a Medicaid rate freeze to hospitals, nursing homes, providers, and payers — at FY 2017 levels, with a 1% rate cut come January 1, 2018.
The taxman cometh — maybe. Raimondo proposed an “Internet Sales Tax Initiative” — which would purportedly equate to $34.7 million in revenues.
"Online sales and the fact that online sellers do not collect sales tax has created a structural problem for Rhode Island's budget — our sales taxes have been flat," said Director of Administration Michael DiBiase, of the tax that Amazon collects in 33 states, but not Rhode Island. "We think mostly due to online sales, we’re able to capture the growth. The revenue number is $35 million dollars — it improves our structural deficit problem. It’s an important fiscal development."
Long Term Care Funding
The Governor’s proposal recommends “redesigning the nature” of the State’s Integrated Care Initiative, by transferring long-term stay nursing home members from Neighborhood Health to Medicaid Fee-for-Service and repurposing a portion of the anticipated savings (from reduced administrative payments to Neighborhood Health) for “enhanced services in the community.” “The investments in home- and community-based care will help achieve the goal of rebalancing the long-term care system," states the Administration.
Cutting that program is tagged at saving $12.2 million; cuts and “restructuring” at Health and Human Services is slated to save $46.3 million.
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