State Medicaid seeks millions for competitive worker wages

Budget request would also better fund nursing homes, eliminate most copays

In eight years, Amy Wiedeman has never been able to hire enough people to provide all of the health care her son needs to stay in their Centennial home.

Luke Schiller, 12, has cerebral palsy and other health conditions that qualify him for around-theclock care at home.

He needs someone watching at all times to make sure he doesn’t have a seizure or choke on his saliva, and to deliver medications through his feeding tube and reposition him so he doesn’t get pressure sores, Wiedeman said.

She and her ex-husband Rod Schiller handle some “night shifts” with Luke and stay home with him on weekends, but it wouldn’t be possible to hold a job or even go to a different part of the house to start a load of laundry if they didn’t have help, she said.

“We could not function without it,” she said. “It requires a lot of hands-on nursing skill, and that’s just to get through every day.”

Medicaid covers Luke’s home care, but it’s difficult to find qualified nurses who are willing to work for the rates it pays, Wiedeman said.

She estimated they’ve had about 20 nurses over the last eight years, with many leaving for more-lucrative jobs, though their current day and night nurses have been with them six and three years, respectively.

“The wages are not competitive enough,” she said.

Colorado’s home care providers might get a raise next year, if legislators grant a request from the state agency that runs Medicaid for money to raise those wager, increase rates paid to nursing homes and more.

Whether it will be enough to attract more workers to the field is an open question, though.

The Colorado Department of Health Care Policy and Financing has asked the state Legislature for $85.2 million in the fiscal year starting in July to raise rates, which is about a 1.7% increase in the agency’s state funding.

With federal funds included, the department spends about $14 billion on Medicaid.

The agency’s budget request includes:

• $28.5 million to increase wages for home health workers

• $19.6 million to increase rates paid to nursing homes

• $9.8 million to increase Medicaid rates by 0.5% for most providers

• $8.8 million to increase rates for group homes and nonmedical transportation

• $2.1 million to maintain new information technology infrastructure in rural hospitals and clinics

About $2.2 million of the

request would go directly to reducing costs for Coloradans covered by Medicaid by getting rid of most copays. Currently, copays range from $1 for lab tests to about $27 for inpatient hospital care. If the department’s request is approved, the only copay would be for using an emergency room for routine care.

The department also is seeking to “rebalance” rates, increasing them for the lowest-paid providers and decreasing them for those getting the highest payments, as a percentage of what Medicare or other states pay. The impact will vary for individual practices, but the state expects to spend more on vision services, primary care and lab tests overall, while spending less on assessing recipients’ cognitive capabilities, radiology and vascular care.

Normally, nursing homes can’t receive more than a 3% annual increase in rates, but the department’s budget request noted that may not cover the rising cost for staffing and supplies. It asked for a 5.86% increase in the coming fiscal year, plus an additional $5 per person per day for homes where 75% of the residents are covered by Medicaid, and $10 per person per day for homes where 85% are. Altogether, the average home would receive $18.37 more each day.

Doug Farmer, president and CEO of the Colorado Health Care Association, said he appreciates the proposal, but nursing homes will need a larger increase to make up for increased costs they’ve faced over the last three years.