State pushes back timeline for Medicaid bonuses; group home providers eye long-term solutions

Medicaid costs
Medicaid home and community based service providers, workers won't get bonuses by the end of the year, state says.

Florida may be getting a boost in money intended to help people with intellectual and developmental disabilities, but it doesn’t look like those additional federal Medicaid funds are going to be handed out soon.

And that’s a conundrum for a system that already is under strain.

The hopes were this “bonus money” could be distributed by the end of the year, but the administration of Gov. Ron DeSantis has pushed back the timeline to distribute the funds with the goal of having the money distributed by “winter 2022.”

Given the federal government approved the state’s plan to bolster home- and community-based services in September, the timeline has some wondering why it could take five months to see the money.

“It can’t come fast enough,” Sen. Aaron Bean, chairman of the health care spending panel, told Florida Politics Monday.

Agency for Health Care Administration Chief of Staff Cody Farrill told members of the Senate Appropriations Subcommittee on Health and Human Services earlier this month that the agency’s goal is to post employer and employee bonus applications on its website in December.

Of the $1.2 billion in additional federal money coming Florida’s way, the state is setting aside $403 million in one-time stipends for employers to apply for and another $266.6 million for their employees, Farrill said.

He said the AHCA is developing potential distribution methodologies but won’t finalize any until it determines how many employers applied for the stipends. Provider caseload will also be taken into consideration in the distribution formulas, but Farrill in his testimony offered few other details.

“We understand we want to get this out the door as quickly as possible, but also want to balance the fact that we make sure these (payments) are going to the right providers that are eligible,” Farrill said.

Philadelphia transplant Tamika Walker moved to Florida in 2014 to help care for her husband’s 100-year-old grandmother. Walker initially was hired by United Community Options of South Florida seven years ago at $10 an hour. After getting promoted, she now earns $11.30 an hour, well below the $17 hourly wage she was paid in Philadelphia.

Though she hasn’t gotten a pay raise since her promotion in 2015, Walker heaps praise on her employer. She told Florida Politics that while she’s able to “make do” because of her husband’s salary, she works with others who are financially struggling. Some staff, she says, can’t afford their own cars. They rely on Uber and Lyft to get to work.

“If they want to do it, just do it. Don’t tell us about it. Just do it.” Walker said of the pay raises. “We are trying to come out of a pandemic. We had to go to work every day and put our lives on the line.”

The DeSantis administration moved over the summer to take advantage of a 10% bump in federal Medicaid dollars available under the American Rescue Plan Act of 2021. Every state moved to tap into the increased federal funds, Farrill said.

Most Florida Medicaid patients who receive home- and community-based services either are enrolled in the Medicaid managed long-term care program or the Medicaid iBudget program. The former is for frail and elderly individuals who qualify for nursing home placement but choose to receive assistance with daily living activities, such as eating and dressing, that enable them to continue to live in their homes or another non-institutional setting.

Similarly, the Medicaid iBudget program allows adults with intellectual and developmental disabilities to tap into the home- and community-based services they require to continue living outside of an institution and in their family home or a group home.

Lawmakers in recent years have committed additional funding to serve more clients and whittle down what has been a lengthy waitlist. For the iBudget program to work, however, there must be a provider network willing to serve the clients. And there are worries that Florida’s network is beginning to erode.

The Agency for Persons with Disabilities reports that between March 1 and Sept. 30, 99 group homes closed, requiring relocation of 271 clients. But during that same time span, the state reports, 108 new group homes were licensed. The APD data doesn’t indicate how many clients the newly licensed homes serve.

The Florida Association of Rehabilitation Facilities data on closures tracks APD’s but FARF did not have information on new facilities opening.

FARF President and CEO Tyler Sununu said many of the group homes that remain open have stopped accepting new clients or have limited the services they provide. Sununu surveyed his group home members this summer and found that on average there has been a 41% turnover rate at the facilities.

The survey also showed that 23% of the positions at group homes are vacant, Sununu said.

Sununu attributes the 100 closures group home closures to the trifecta of the COVID-19 pandemic, a tight labor force, and historically low Medicaid reimbursement rates

“We were really hoping the money would be available for the holidays and it looks like it’s not going to be. And that’s unfortunate,” he said. “But we are really happy the money will be coming.“

Sununu, though, has his eye on the bigger picture: getting lawmakers to increase by $147.5 million the amount Medicaid pays providers. Of that increase, about $93 million would be funded with state general revenue. The remainder comes from matching federal dollars. The increase, he maintains, would allow group homes to pay direct care workers an average $14 an hour, up from the current average wage of $11 an hour.

Bean has either helped craft or has taken the lead on developing the state’s Medicaid spending plans during most of his lengthy legislative career. He says he is awaiting the results of a state-contracted study on the state’s new minimum wage requirements and the impacts it will have on the rates providers need to be paid.

Bean said APD will get its attention during the 2022 session but made no promises about increasing provider rates.

“I fully acknowledge they are struggling. But everybody is struggling. Nursing homes are struggling, retailers are struggling, restaurants are struggling. It seems like everybody has a supply chain crunch and a working shortage. So this industry is not spared from all of the above,” he said.

Florida Developmental Disabilities Council Executive Director Valerie Breen is less focused on the home- and community-based industry and more focused on the workforce needed to provide services now and in the future

“Definitely we need providers. But more importantly, there isn’t the workforce there to support them. That is the critical issue,” she said.

While APD certifies direct support professionals who can work in Florida, Breen said there is no professional designation for the staff, whether they provide home- and community-based services at a family home or at a community group home. She said the workforce needs to be recognized and incentivized.

“It is a huge crisis nationally and we are definitely seeing it in Florida,” she said.

To that end, Breen said the Council will launch a message campaign dubbed “Pay Fair for Care.” She said hundreds of constituents will share their stories with lawmakers about the difficulty in getting direct support professionals.

“We are looking at an extreme caregiving situation. Where families are having to take it on,” she said. “They are absolutely having to take it on and they aren’t getting any support because the workforce that we depend on for direct support professionals is slowly and surely diminishing.”

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.



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