The Maryland Department of Health is closing public comment asking for input on what to spend the remaining $171.45 million designated for Medicaid home and community-based health care services on Nov. 15, 2021 — about a month after opening.
A public notice was issued by the health department in mid-October allowing interested parties such as; organizations, Medicaid providers, Medicaid beneficiaries and their families, and the workers themselves to voice their opinions on how to use the funds from the American Rescue Plan Act of 2021.
In a letter to the state Medicaid director from the Department of Health & Human Services Center for Medicare & Medicaid Services on May 13, 2021, the estimated $228.6 million awarded to the state for health services should be used to “address COVID-related concerns during the period of the public health emergency.”
The document gives several examples of how funds can be used to respond to the worker shortage and lack of access to care for beneficiaries due to the COVID-19 pandemic like giving Medicaid provider increases, direct worker payments, hazard pay, and worker benefits.
When the Maryland Department of Health released its spending plan on July 13, 2021, it allotted that 75% of funds would go to Medicaid reimbursement rate increases for the nearly 500 home and community-based providers in Maryland that receive Medicaid funding. However, the plan did not require providers to use the additional funds for a worker wage increase.
For several years, there has been a home care worker and caregiver shortage in the mid-Atlantic region that began long before the pandemic, according to Dawn Seek, the executive director of the Maryland-National Capital Homecare Association.
“The shortage right now is at a fever pitch… the pandemic made it worse because people were afraid to go to work,” Seek said.
Since COVID-19, there has been a high demand for those more vulnerable to the virus, but have more manageable disabilities, to leave long-term care facilities covered by Medicaid to move to home care.
The care worker shortage has led to longer waitlists in the state of Maryland amounting to an estimated 15,000 to 20,000 people, according to Mike Bullis, the executive director of The IMAGE Center of Maryland.
“We need to reduce those numbers. We need to give these people money. Pay the workers. They need to get paid,” Bullis said.
The necessity and quality of care in an industry predominantly made up of women of color has been a priority for many organizations fighting the cause for higher wages across the country.
Attorney David Rodwin has been working with the Public Justice Center for the last six years advocating for job quality for home care workers in Maryland. Rodwin has been at the forefront of trying to change the system in Maryland to protect home care workers’ rights and give them a fair wage.
“These jobs are very often bad jobs, the job quality is very poor, and the pay is too low. That is why there aren’t enough workers entering the field,” Rodwin said. “The way to fix that is to make them better jobs, and the way to make them better jobs is to make sure that workers are paid enough to live on.”
For Rodwin, the Maryland Department of Health’s designation of funds from the American Rescue Plan Act of 2021 was another missed opportunity to help fix the problem.
“The state has blinders on about how this workforce is being treated with state money,” Rodwin said.
Out of 51 states, including D.C., a total of 18 states opted to require funds be given to direct care workers. Maryland was not among the states to include a temporary wage increase. Some states also chose to increase benefits or hazard pay as a form of aid — Maryland did neither. However, Maryland was one state that provided one-time bonus payments, but there is no indication those bonus payments went to the workers themselves.
Starting Nov. 1, 2021, providers got a one-time Medicaid reimbursement increase that raised hourly Medicaid rates for personal assistance services from $19.50 to roughly $20.50, according to a memo issued by the Maryland Department of Health on Nov. 3.
At this time the state of Maryland has no current legislation that requires home care agencies to report their worker’s wages to the state. During the 2020 Legislative Session, a bill was introduced in the Maryland Legislature that would have required that homecare agencies receiving Medicaid money report to the state how much they pay their workers with that money.
Maryland Senate Bill 384 was passed in the 2021 Regular Legislative Session, however, it didn’t include the reporting provisions because the homecare groups objected to the reporting, Rodwin said.
“The state needs to know [and] policymakers need to know how much these workers are being paid, and what other attributes that their jobs are so that they can make policies for the state funded workforce, and the failure to ask for that information is in part why we have this massive worker shortage now,” Rodwin said.
The lack of wage reporting accompanied by the unspecific terms of how the 75% Medicaid rate increase should be used by Medicaid-funded agencies, the use of funds to increase the wages of home care workers is left to the discretion of the agency.
Maryland’s initial spending plan announced in mid-July also did not include how the rest of the funding would be allocated but said that “plans for the remaining funds are under consideration and will include stakeholder input.”
When several weeks passed without a forum for stakeholder input, advocacy groups like 1199SEIU United Healthcare Workers East, Public Justice Center, and Maryland-National Capital Homecare Association banded together to bring attention to its non-existence.
On Sept. 15, 2021, the network of organizations and advocacy groups wrote a letter to Maryland Department of Health Secretary Dennis R. Schrader to express their concerns over the lack of stakeholder engagement for funding that didn’t happen prior to the release of the plan nor after.
“MDH [Maryland Department of Health] did not establish a process by which stakeholders could submit written comments on how the money should be spent. Nor has MDH published the letters that some stakeholders nevertheless sent to MDH outside the formal process. In short, MDH did not establish any process for stakeholder input whatsoever,” the letter said.
It was only after the letter was received that the Maryland Department of Health followed up with the network’s request that they “establish an organized, public process to engage, seek input from, and update stakeholders concerning these critically important federal funds.”
The Southern Maryland Chronicle reached out to the Maryland Department of Health for comment regarding the decision to not include a wage pass-through in its plan, intended uses for the remaining 25%, and the lapse in time between the plan and executing a platform for stakeholder engagement. A media representative for the Maryland Department of Health directed The Southern Maryland Chronicle to refer any inquiries to the Maryland Medicaid Public Notices page.
Public comment forms are due no later than Monday, Nov. 15, 2021. Submissions can be filled out digitally on the Maryland Department of Health’s website.