How to Handle the Service Provider Capacity Crisis
Great! You are thrilled to have gotten onto a Colorado Medicaid and/or a Medicaid HCBS waiver. You see the list of possible services and therapies. Then, you actually try to find providers and realize that the real work now begins. Program approved service agencies (PASA) don’t have the bandwidth or staff to find direct service providers for you. They are saying that YOU can do the hard work of finding the staff for them to hire. Great, just what you need, more work!
How did we get here?
Medicaid Case Management Agency and Direct Service Provider structure
In Colorado, we have a privatized system. The state Medicaid agency, Health Care Policy and Financing (HCPF) contracts out both waiver case management (CMA) and direct services program approved service agencies (PASA) or consumer-directed attendant services and supports (CDASS) to private companies. It used to be that one organization was allowed to manage both these services, but in 2014, a Federal Final Rule determined this to be a conflict of interest, meaning they could no longer do both, hence we have the current changes known as Colorado case management redesign. However, there is a rural exception allowing many CMAs to still do both in non-urban areas.
I agreed that there was a conflict of interest allowing both in one agency. I personally experienced ‘steering’ of case managers to use their in-house services for my son. But, I strongly believe that the ‘walmart’ approach of only one size and style of case management is not friendly to consumers and never should have been adopted.
The direct service companies, Program Approved Service Agencies (PASAs) are at the mercy of the rate schedule that the state Medicaid agency HCPF controls, unless the Joint Budget committee overrules them.
The Colorado HCBS structure currently is oriented to support the bigger contractors and in general, disabled people, their families and caregivers lose out.
The HCBS Waiver Workforce is Majority Women, Non-union and Grossly Undervalued
Society continues to undervalue home and community based care workers and turnover is high. Families are forced to source their own staff, which is a huge undertaking when already exhausted and overwhelmed with their own caregiving. Unionization may be the path, if leaders fail to listen.
State Cost of Living Exceeds Raises
Medicaid has always paid lower rates than commercial insurance. Then add decades of small 2% raises to Medicaid providers when inflation is much higher and soon there is a huge 30%+ difference in Medicaid rates versus the marketplace. Medicaid continues to fall further behind market rate and they lose medical providers such as doctors as well as medical billed therapists (speech, occupational, physical therapists and applied behavior analysis providers). The providers for home and community based waiver services are struggling to meet the high demand for staff in a field that is not seen as a lucrative or fulfilling career pathway.
Residential Care and Future Needs
There is a growing demand for home and community based services, as our population ages and disabled people want to live independently in their own place. The host home model is more challenging with Colorado’s high cost of living. There will be an increasing need for more ‘push in’ and remote support into clients’ homes.
3 Badass Suggestions for Fixing the System
Create Access to Providers: To simplify connection between providers and clients, NDC is developing an online membership platform to connect caregivers with Colorado service providers. each indicating which skills are needed and which PASAs they use for billing HCBS services. This will simplify the process of finding experienced providers, since agencies expect caregivers to source their own staff.
Medicaid Rate Increase Advocacy: Organize families and workers to demand our leaders address the broken Medicaid Rate Review process in Colorado. Raise all the HCBS waiver services rates 40-100%. Review and raise medical reimbursements, with special attention and incentives for adult specialty care and mental health service.
Widen the Employment Pool: Lower the minimum age of HCBS waiver providers from 18 to 16 for HCBS waiver services (this was recently approved in another waiver). A 16-year-old can currently get a Certified Nursing Aide (CNA) license in Colorado, but not work as a waiver provider, which doesn’t make sense.
4 Tips to Help you find providers NOW
Sign up with NDC to get upcoming announcements about the launch of DisabilityCareColorado.com so you can find providers more easily.
Review your PASA options and choose a PASA that makes onboarding new providers as easy as possible.
Skill up: Watch the NDC Building your Respite Bench free video workshop to learn how to find direct service providers! https://youtu.be/esGoJaTU2C4?si=TnQl9jCzZ_XQh5xi
Find Medical Providers: Seeking Medical specialties which take Medicaid insurance:
Use https://www.healthfirstcolorado.com/find-doctors/
You can also contact your Regional Accountability Entity (RAE) for referrals https://www.healthfirstcolorado.com/health-first-colorado-regional-organizations/