Countdown to the Vermont Legislative Session

The 2020 legislative session is fast approaching. It will be the second year of a two-year biennium which means any bill that had not yet passed at the end of the 2019 legislative session picks up where it left off. Controversial bills often require a full two-year biennium to make it through the entire process.
Such is the case for the minimum wage and paid family leave bills, both of which failed to pass when negotiations to reconcile the House and Senate versions stalled. Eventually, in an unusual move, the House brought the session to an end without agreement from the Senate.
Since then, House and Senate leaders have been working toward a resolution and both bills are widely expected to move quickly toward final votes in January.
Health care providers have been asked to provide extensive wage data to the legislature’s technical staff to estimate a Medicaid increase needed to fund wage increases for entry-level workers. This sounds simple, but the policy questions are complex. It is critical that policymakers address the reality that home health agencies and other providers are already operating Medicaid programs at a substantial loss to fund the wages they pay today.
Our concern about those losses underscores why this session, the VNAs of Vermont will advocate for the legislature to address the chronic underfunding of the Medicaid long-term care program known as “Choices for Care.” The program is in serious trouble. It was designed to shift long-term care to community settings and away from nursing facilities—and it succeeded. Nursing facilities have reduced their size or closed entirely. Home health agencies and other community providers have helped countless Vermonters stay independent in their homes. But the program is reaching a tipping point. It is severely underfunded. Home health agencies are spending 27 percent more to provide the program than they are being reimbursed for their services. Inadequate funding means wages for individuals providing the personal care services that form the foundation of the program are not competitive. In a tight labor market, finding staff is increasingly challenging. Agencies are reporting a 25 percent vacancy rate and a 50 percent turnover rate for personal care attendents (PCAs). Meanwhile, a federal regulatory requirement may force the Vermont Department of Disabilities, Aging and Independent Living (DAIL) to restructure the program in a way that will exacerbate the crisis. Whether or not Vermont will apply for­—or obtain—a waiver is uncertain at this writing.
The Choices for Care program is the result of the thoughtful, bipartisan efforts of legislators and state officials across several administrations. I believe the time has come for them to evaluate and address the sustainability of the program to ensure that it available for older and disabled Vermonters for years to come.

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