Pa. plan to bump pay offers clues on how to spend $400B
WASHINGTON — Pennsylvania officials in Harrisburg are mulling pay increases, bonuses and student loan forgiveness for the state’s care workers who provide home and community-based services — part of a plan to spend an additional $1.2 billion in federal funding for those services that allow seniors and people with disabilities to live independently.
The proposed strategy, submitted to the federal Centers for Medicare and Medicaid Services, was put up for public comment that ended July 6, offers clues for how a significantly bigger pot of money might be spent.
Congress is debating President Joe Biden’s request to spend as much as $400 billion nationwide to boost the workforce and provide home and community-based services to every person who wants them.
Sen. Bob Casey, D-Pa., a memberof the Senate Health and Human Services Committee, is serving as a chief spokesperson for expanding the services, which is one of the central pillars of Mr. Biden’s infrastructure proposal unveiled near Pittsburgh in March.
But the fate of the funding is unclear. Congress is negotiating a bipartisan framework that focuses on physical infrastructure and a separate, Democrats-only bill that currently does not have the votes to move forward and may not include the funding Mr. Casey wants.
As Washington tries to find a deal this summer, Pennsylvania officials are working to spend additional dollars for those services that Mr. Casey secured in the American Rescue Plan, the $1.9 trillion COVID-19 relief measure that Mr. Biden signed into law in March.
Those funds became available in May, and states are drafting their individual spending plans.
The state’s plan takes aim at the central problem: a lack of resources that has created a shortage of service providers.
It’s a systemic problem across the country as more people, beginning in the 1980s, have moved from institutions like nursing homes and group settings and tried living on their own. The number of workers who can provide specialized services, ranging from life coaching to medical care, has not kept pace with demand.
Across the country, more than 4.2 million people receive care in their homes or communities, another 800,000 people are on a wait list for those services.
In Pennsylvania, 12,000 people with intellectual disabilities
were waiting for services as of February, including about 3,500 people waiting in the Pittsburgh region and nearly 1,000 people waiting in Allegheny County alone, according to state data.
Families often are required to step in to care for loved ones who are aging or who have disabilities.
Last month, the Pennsylvania Department of Human Services released an eightpage plan that proposed a wide range of workforce supports and better services through existing programs.
The department pledged, among other things, to implement an online education and training portal for shiftcare nursing, fund a medical home program to focus on care for children with complex medical conditions; and provide financial support to adult day centers to deliver services safely.
The department stated it would offer sign-on and retention bonuses, and increase rates for direct support professionals working in some programs. But it was light on what, exactly, those increases would be.
For workers under the Office of Developmental Programs, which funds services to people with intellectual disabilities, the department promised only that it would “refresh data” and “adjust rates if necessary.”
That promise was not enough for Nancy Murray, senior vice president of Achieva, a Pittsburgh-based organization that serves people with disabilities and their families.
“I think at this point everybody in the intellectual disability community would agree that the No. 1 priority for us is that the funding has got to go toward recruiting and retraining direct support professionals,” Ms. Murray said.
Nationally, wages for 3.4 million home health and personal care aides sat at $13.02 an hour last year, according to the U.S. Labor Department.
The Provider Alliance, a Pennsylvania nonprofit advocating for direct support professionals, has pegged the ideal base wage rate at $18.20 an hour. That would require, the group estimated, the state to spend another $542 million to lift wages for the 55,000 direct service professionals statewide.
The industry is losing people to Amazon warehouses and fast-food restaurants, Ms. Murray said, forcing some programs to close altogether.
“We’re beyond a crisis right now, when it comes to not having enough staff,” Ms. Murray said. “We’re trying to keep pace with retail, with manufacturing, with the hospitality industry — and we can’t do it.”
The department spokeswoman said it was awaiting approval from the Centers for Medicare and Medicaid Services. More specifics on pay increases may become available in coming weeks. The department was still working to publicize comments filed on the plan online and could not provide those to the Post-Gazette as of last week.
CMS could not respond to a request for comment by this story’s deadline last week.
In Congress, lawmakers are negotiating more funding.
Senate Democrats unveiled a $3.5 trillion measure with many of Mr. Biden’s “human” infrastructure priorities, which they said would be advanced through a budget reconciliation process that requires no Republican support. The home carefunding component was included in that measure, but the exact dollar amount was not clear.
Meanwhile some Republicans have threatened to pull their support for the bipartisan framework if Democrats try to push such a bill forward on a separate track.
Last week, Mr. Casey joined Commerce Secretary Gina Raimondo and home care advocates to press once again for the funding.
Asked if he has had conversations with other Senate Democrats who may be on the fence about the measure, Mr. Casey said he was confident the funding is a priority.
“This has been a topic of discussion within our caucus for not days, not weeks, months,” Mr. Casey said.
Momentum is building, he said, and it’s not “just my repeated invocation of how important the policy is, but I think a broad and very, very deep consensus within our caucus of the importance of this for seniors, for people with disabilities, for workers.”
The Provider Alliance, a Pennsylvania nonprofit advocating for direct support professionals, has pegged the ideal base wage rate at $18.20 an hour. That would require, the group estimated, the state to spend another $542 million to lift wages for the 55,000 direct service professionals statewide.