LINC Blog, State and Local News

Direct Care Workforce Victories, Updates, and Next Steps

First, we want to thank you for taking the time to stand up for Idaho’s Direct Care Professionals. Whether you completed a barriers to services questionnaire, joined the Statewide Day of Action, or showed up at the Statehouse to attend a committee hearing or speak to a lawmaker, thank you. Your participating has made a difference and we’re starting to see some movement to address the Direct Care Professional workforce crisis. We want to share a few victories on the state level, give you a short update on what’s happening in Washington D.C. with federal legislation, and let you know what’s coming up next in terms of advocacy.

Rate Increase Approved

On March 25, Governor Brad Little signed into law the Health and Welfare budget. This budget includes an increase in reimbursement rates for some Direct Care Professionals. This increase will take place in July. While this increase is welcomed, we know it is still not enough. We need to see reimbursement rates that make direct care work competitive with other jobs and wages in our state.

Two Important OPE Reports

On March 16, the Office of Performance Evaluations (OPE) released a long-awaited report examining how Medicaid sets its rates for programs like Home and Community Based Services. If you’ve never heard of OPE, it’s mission is to “Promote confidence and accountability in [Idaho] state government through evaluation of programs and policies.” The OPE is one of the most respected offices in the state, and the bipartisan Joint Legislative Oversight Committee (JLOC) hears OPE study proposals and decides what studies will be approved.

The Medicaid Rate Setting study identified some major issues with rate setting in Idaho. They reported that Medicaid does not have the management capacity to successfully conduct a systemic rate review, particularly since the division has fewer staff than in 2009 while its budget has more than doubled in the last decade. The report also found that while the Legislature has authority over rate changes, it lacks the information needed to fully understand the impacts of their decisions. Furthermore, the Legislature does not trust the division administration, and the administration is afraid to ask for what it needs.

There were four major recommendations from the report:

  1. Division administration should assess its most urgent needs and present a budget request during the 2023 legislative session.
  2. The Legislature should consider what it wants to control and what it wants to delegate to the division and invest accordingly. The Legislature could consider options such as additional reporting or establishing an oversight committee.
  3. The division should operationalize its measures of access, quality, economy, and efficiency based on Idaho’s priorities and embed these measures in the rate-setting process.
  4. The division’s rate reviews should be regular, public, and incorporate stakeholder input.

This report is good news for Direct Care Professionals and the people they support. A no-nonsense, nonpartisan report like this lays the groundwork for real conversations and action to improve how Medicaid reimbursement rates are set.

But wait, there’s more good news. On March 22, JLOCK approved a follow-up study requested by Senator Michelle Stennett that will take a look at problems facing the Direct Care Professionals and its implications on those who rely on these professionals for support. The Direct Care Workforce study will explore how Idaho can stabilize and strengthen the direct care workforce, including career ladders, pay equity, training, and a worker registry. This report, in concert with the Medicaid Rate Setting report, should provide the Idaho Legislature with information and options to act upon to help address this ongoing and unsustainable problem.

Direct Care Workforce at the Federal Level

The direct care crisis is also being discussed on the national level with state delegates throughout the nation. The National Alliance for Direct Support Workers (NADSP) has lead advocacy efforts by coordinating meetings with congressional delegates in as many states as possible. Meetings with Senator Risch, Senator Crapo, and Congressman Simpson from Idaho have taken place to push for support for Direct Care Professionals.

The following is legislation related to the direct care workforce:

#1: “Recognizing the Role of Direct Care Professionals Act” (S. 1437/ H.R. 4779) – This act would create a standardized occupational classification (SOC) code for Direct Support Professionals. This is important because currently there is no official standard occupational code or formal recognition of the direct support profession. Creating an occupational classification code will allow for the collection of data that will help identify workforce needs.

#2: “Supporting our Direct Care Workforce and Family Caregivers Act” (S 2344) and the “Creation, Advancement and Retention of Employment (CARE) Opportunity Act” (H.R. 2999). There is lack of a clear direct support profession career pathway, lots of demand and skills required, but with little training or supports. The profession experiences low wages, long hours, few benefits, and little advancement, and this legislation would invest in career pathways for Direct Support Professionals.

#3: “Build Back Better Act”. This legislation would expand and enhance Medicaid’s Home and Community Based Services program with an investment of $150 billion. Our nation’s need for independent living supports is rising insurmountably and we need federal investment that match our states’ needs.

#3: “Build Back Better Act”. This legislation would expand and enhance Medicaid’s Home and Community Based Services program with an investment of $150 billion. Our nation’s need for independent living supports is rising insurmountably and we need federal investment that match our states’ needs.

What’s Next?

So, what do we do now? A lot. There’s a lot of work to do between now and the next legislative session. Here’s what we’ll be up to over the next six months, and we want you to join us!

Filing Complaints

Just because the legislative session is over, doesn’t mean the direct care workforce crisis is resolved. In fact, we expect the problem to stay the same or get worse. We will be supporting individuals who continue to experience barriers accessing services – including finding and retaining Direct Support Professionals – to submit formal complaints. Idaho Medicaid has repeatedly stated that complaints through their online portal is the only way they track if there are problems or barriers to services. If you would like to file a complaint, please complete the Barriers to Services Questionnaire and a LINC staff member will contact you. If you previously completed the BTS questionnaire and indicated you want to file a complaint, we will be reaching out to you in the next month or two.

Meetings with State Lawmakers

This summer we will support Idahoans with disabilities in meeting with their state representatives and sharing their personal stories. Lawmaker MUST hear from voters in their districts about how the direct care workforce crisis is impacting the quality of life of thousands of Idahoans with disabilities. Lawmaker must also understand how much more cost-effective home and community-based services are compared to institutional care.

Candidate Questionnaires & Town Halls

It’s an election year and candidates for the Idaho Legislature will be making their case as to why you should elect them to represent you in the Idaho Statehouse. We will be asking every candidate for state office to complete a questionnaire focused on disability issues and the direct care workforce in Idaho. We also plan on holding several nonpartisan town halls so that all of you can learn more about each candidate and ask questions important to you, and so candidates can learn about our issues. Stay tuned for more information.

State Plan for Independent Living (SPIL)

Every three years, the Idaho State Independent Living Council (SILC) works with the Centers for Independent Living (CILs) and the Idaho Commission for the Blind and Visually Impaired (ICBVI), to develop the State Plan for Independent Living (SPIL). The SPIL is a three-year plan that sets goals and guides plans for the delivery of independent living services, systemic advocacy, and public outreach and education.

Before we can develop a Plan, we need to learn more about what is important to Idahoans with disabilities and their families. In the coming months, we’ll be holding town meetings across our state to hear from Idahoans with disabilities. We’re also asking people to take 10-20 minutes to complete our survey so we can learn more about your needs and what matters to you. Your responses are confidential unless you choose to share your name.

The survey is available in English and Spanish. Surveys in English and Spanish are also available in hard copy, large print and Braille. Please contact the Idaho SILC at (208) 334-3800 if you need help or to request a survey be mailed to you. To print out and mail back a survey, the pdf is available in English and Spanish.