Colorado Medicaid asks to raise pay for nursing homes, home health

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-the-clock 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.

The group hasn’t settled on a specific rate they intend to ask for, but is talking with lawmakers about the need to increase pay so homes can hire more people and accept more patients, he said. Around the country, patients who need rehabilitation before they can return home have been stuck in hospitals because they couldn’t find a nursing home with space available.

“We’re looking for a base rate that gets closer to the actual costs,” he said.

For home- and community-based service providers, the proposal would raise rates to cover increased minimum wages. The hourly minimum for home care workers is now $15.75 statewide and $17.29 in Denver.

Matt Hansen, deputy executive director of the Home Care and Hospice Association of Colorado, said a rate increase is necessary to keep programs open to Medicaid patients. Last year, the state increased Medicaid rates to cover a $15 per hour minimum wage, but providers are paying $16 to $20 per hour, depending on the county, he said.

The increased minimum wage has brought back some home care workers who had left for higher-paying jobs in other industries, and the association supports continuing to raise pay, but rates have to keep up, Hansen said. The group also will press for increased reimbursements for physical therapy, occupational therapy and private duty nursing, which serves children with complex medical conditions, he said.

“We’ve been hit not only by the minimum wage increase, but by inflation,” he said. “Sometimes these providers are actually losing money.”

Wiedeman said the shortage of people working in home health means there’s no backup if something goes wrong. When their day nurse got sick and was off for more than a week, she and Schiller had to take turns calling off work to watch Luke and manage his daily routine.

By noon on Tuesday, that included giving multiple medications and two feedings through a tube in his stomach; two diaper changes; dressing him and brushing his teeth; moving him from his bed to his wheelchair, then to a padded standing desk that supports him, then back to bed; stretching his limbs with every transfer to reduce muscle contractures; and two treatments with a vibrating vest to break up mucus in his lungs and a different machine to push him to cough it up.

All the while, Wiedeman must keep an eye on Luke’s blood oxygen levels and watch for seizures and choking.

It wouldn’t be feasible for her — or for parents of kids with similar needs — to work, or even care for their other children without professional help, Wiedeman said. When their normal day nurse leaves for the evening, she has to run back and forth between helping her daughter Sage Schiller, 14, with geometry and suctioning saliva whenever Luke coughs.

“So I don’t do either well,” she said. “You’re trying to be an (intensive care unit) nurse and a regular mom.”

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