When Gov. Roy Cooper vetoed the state budget, as passed by the General Assembly, he vetoed a possible pay raise for personal care workers who provide care for older adults.
A pay raise that some would say is overdue.
The line item in the Medicaid spending portion of the budget increased the hourly rate of pay reimbursement, which likely will lead to pay raises for those in the industry in the state.
Although some home healthcare services are covered by Medicare, one of the many things that fall under the umbrella of Medicaid is personal care for qualified individuals. Individuals qualify by meeting maximum income/asset thresholds for Medicaid, and with medical conditions, that impede their ability to perform certain “Activities of Daily Living,” such as eating, dressing, bathing, toileting and mobility.
In North Carolina, the companies contracted to provide personal care have historically received a reimbursement rate that has lagged behind the national average. Over the past eight years, the hourly rate has been $13.88. The recently passed budget raises that rate to $15.60.
Recent data shows that the national average rate of reimbursement is $18.82 per hour.
Since 2011, the General Assembly has been prudent when it comes to allocating recurring funds to the state budget. Rep. Nelson Dollar (R-Wake), chief budget writer for the House said, “Along with the Department of Health and Human Services, we looked and found that some of these companies are having a very difficult time being able to hire and retain quality people. That is what is driving these modest rate increases.”
Dollar also said that the hope is to provide adequate funding for the service, which applies to personal care given in home and in adult-care homes. The reimbursement rate applies to both.
Employees do not receive the full amount, as the company not only has to pay them, but also cover other costs out of that reimbursement.
Bill Lamb, executive director of the nonprofit organization, Friends of Residents in Long-Term Care said, “As the older adult population grows, the need for personal service care increases, too. I think the General Assembly wants to do things to support older adults, but I also think they are cautious when it comes to the rapid growth of the older population, when considering a recurring financial commitment.”
North Carolina’s older adult population is growing at a rapid rate.
For example, in a presentation to the General Assembly in 2016, the UNC Population Center predicted that current demographic trends will have one in five residents of the state aged 65 or older. Further, half of the state’s two million new residents in the next 20 years will be aged 65 or older.
Data from the NC Coalition on Aging show that by 2018, the state will have more population 60 and over than age 0-17.
The Medicaid personal care reimbursement goes to the employer, and Lamb said there is a good faith belief that they will pass the increase on to their employees as intended.
“Personal care organizations have been dropping out of the market,” Lamb said. “After all, these companies are in business, and their bottom line is as essential to them as it is with any other business.”
Adding that there is huge turnover in the home health care market, Lamb said personal care services is a very unstable labor market as there are more job alternatives with higher pay.
Lamb said, “Personal care work is hard work and the pay is not great. If you can get paid more at McDonald’s turning hamburgers than you can providing personal care for an older adult, it doesn’t take much to make the decision to go somewhere else.”
Mary Bethel, president of the NC Coalition on Aging said in an email, “Aging advocates are very pleased that the General Assembly increased the reimbursement rate for Medicaid personal care services in the last legislative session. This was a priority issue for the NC Coalition on Aging. This increase will help to boost wages paid to the direct care aids, and will assist agencies with the recruitment and retention of workers. All of this should result in helping to provide more stability to the long-term care system.”
Bethel added, “We hope that the General Assembly will consider increasing the reimbursement rate for the Community Alternative Program for Disabled Adults in the next legislative session, which aging advocates had also requested this year.”
Cooper vetoed the entire budget and in so doing put the reimbursement rate increase at risk. To the relief of companies and employees who provide the ever-increasing need for personal care for older adults, the General Assembly overrode the veto.