Idaho disability advocates stress need for more Medicaid staff, direct care workers

BOISE (Idaho Capital Sun) — Idaho lawmakers on the Medicaid Managed Care Task Force spent Thursday morning listening to representatives from disabilities communities in Idaho regarding their concerns about potential changes to the Medicaid system.

Most speakers pointed to the lack of staffing for direct care workers, as well as the lack of staff in the state’s Division of Medicaid. Multiple speakers referenced a report and recommendations from the Office of Performance Evaluations on the sustainability of the direct care workforce, released in February.

Christine Pisani, executive director of the Idaho Council on Developmental Disabilities, spoke on behalf of the Our Care Can’t Wait Coalition, which wrote to the task force in July about its concerns around changes to the Medicaid system.

She stressed the importance of adding staffing to the Division of Medicaid and increasing the number of home-based caregiver workers.

“Year after year, I observe the demoralizing effects on the staff at the Division of Medicaid who are repeatedly unable to meet the expectations of our state,” Pisani said. “I’ve watched countless quality staff leave the division because the workload is too tremendous due to too few staff.”

Recommendations are often proposed, but the division always says they don’t have the capacity to implement them, she said.

“If we are unable to maintain the home- and community-based service system, the cost to the state will be four to five times more through out of state placements and higher cost of institutional care,” Pisani said.

Staffing vacancies can lead to negative health outcomes, Idaho disability advocate says

David Lehman, representing the Idaho Association of Community Providers, told the committee that staffing vacancies for the association are at about 30% and that overtime makes up about 15-25% of payrolls. Asking employees to spend that much time working overtime while being paid about $15 an hour isn’t sustainable, he said. Even with the overtime, there is a significant waitlist of people that need to access services.

“We may see more institutionalization as a result of people not being able to access services in the community,” Lehman said. “Not only is it cheaper to provide services in community, but we don’t have to build facilities to do it.”

He hopes the Idaho Department of Health and Welfare would support training for direct care workers to help run those platforms. He also told committee members that he hopes to professionalize direct care and help people see it as a potential career with advancement options.

Legislators asked Lehman what he believes the result of switching to a managed care Medicaid system could mean for the association.

“There already is a management structure in place for individuals, whether they have a disability or not, [who] have the Healthy Connections provider and are referred out for services,” Lehman said. “So adding that next layer of complexity, I’m not sure it benefits at all individuals with disabilities. The system as it is now provides some of those protections for the taxpayer, making sure people are getting the right care at the right time.”

The goal of task force is to study cost-effective managed care after the 2023 budget request for Medicaid hit $4.7 billion. The Thursday meeting also included a review of other states’ Medicaid managed care plans.

After Idaho voters approved Medicaid expansion in 2018, eligible enrollees include people younger than 65 who are under 138% of the poverty level. Others who are eligible for Medicaid include pregnant women who are under 138 percent of the poverty level, people with disabilities, and people 65 years and older who meet certain income requirements.

The Medicaid Managed Care Task Force meets next on Sept. 11.