States are tackling home healthcare worker shortages by increasing Medicaid payments and enhancing education and training. The KFF brief reveals all states, barring Florida, faced staff scarcities in 2023, affecting various care providers. Responses included higher wages, training programs, and incentives for retention and recruitment. Additional strategies involved setting minimum wages and offering sick leave. The sector’s broader issues reflected in nursing facilities, with new federal staffing requirements posing further challenges, prompting bipartisan concern over their potential impact on already burdened nursing homes.
Amid staffing shortages, states are not only increasing Medicaid payments but also broadening training and education for home healthcare workers.
A majority of states have raised Medicaid payments to home healthcare providers, battling staff scarcities, as detailed in a KFF issue brief.
The pandemic intensified workforce issues in Medicaid home- and community-based services (HCBS), covering home health, personal care, and waivers for groups like individuals with disabilities.
This information stems from a survey of state Medicaid HCBS program officials conducted from May to August 2023, showing efforts to tackle workforce shortages as pandemic-related flexibilities end.
Florida was the sole non-participant in the survey, with varied response rates across different queries.
Workforce shortages in 2023 were reported by all participating states, including Washington, DC. Notable deficits were seen in direct support professionals (50 states), personal care attendants (49 states), and nurses (49 states). Shortages also emerged in home health aides (47 states), case managers (45 states), community-based mental health professionals (38 states), and therapists in occupational, physical, and speech fields (35 states).
These gaps are partly attributed to low pay rates and stringent provider requirements. In 2021, HCBS workers in focus groups described their roles as physically and mentally taxing.
HCBS facilities, like adult day programs, group homes, and assisted living, have shut down in numerous states. Out of 37 states, over two provider types reported closures, impacted by provider shortages and pandemic hurdles.
In response, 48 states have increased provider payment rates. Although some states enacted permanent hikes, temporary increases were noted in 13 states. Only 14 states have cost-of-living-adjusted payment formulas, not universally applied across staff roles.
Forty-two states are enhancing or initiating worker training and education, with 41 states offering incentives for staff recruitment and retention.
Additional measures include raising state minimum wages (20 states) and introducing paid sick leave (19 states). Efforts also focus on connecting job seekers with employers, engaging prospective employees, and using social media for recruitment.
Of the states setting payment rates based on time, 34 reported such a practice, with 20 paying less than $20 per hour. Average rates were $19/hour for personal care providers, $28/hour for home health aides, and $43/hour for registered nurses in home and community-based settings.
These shortages in the Medicaid HCBS workforce mirror broader issues in long-term services and supports (LTSS), particularly in nursing facilities post-pandemic.
The Biden Administration’s proposed rule imposing minimum staffing levels in nursing homes could intensify these challenges. The rule mandates specific daily care hours per resident from nurses and nurse aides, with less than 20% of facilities currently meeting these standards, according to a KFF brief.
Representative Greg Pence (R-IN) and colleagues voiced their concern to HHS Secretary Xavier Becerra in a bipartisan letter. The letter criticized the potential regulatory impact on already-strained nursing homes, especially in rural areas. Congressman Pence urged a reevaluation of the proposal, fearing widespread negative outcomes and restricted access for seniors requiring nursing home care.
