By Ruth Brown, Idaho Reports
Members of the Joint Legislative Oversight Committee were tearful Friday morning as they heard testimony from multiple disabled people about their struggles to find direct care workers.
The testimony came as the committee heard from stakeholders about a report from the Office of Performance Evaluations on the sustainability of Idaho’s direct care workforce. OPE found that the state needs about 3,000 more direct care workers to meet national staffing levels to serve disabled Idahoans.
If demographic and workforce trends continue, OPE estimated that by 2032 Idaho will need more than 9,500 new direct care jobs to reach national staffing levels.
The Idaho Council on Developmental Disabilities invited a man from Meridian, Noll Garcia, to share his experience trying to find direct care workers. Garcia, 51, has cerebral palsy, uses a wheelchair, and has a vision impairment. He needs assistance with meal preparation, bathing, getting dressed, and other daily tasks.
“Because of the direct care workforce crisis, I’ve spent every day of the last three years never knowing if my personal care services would show up,” Garcia told the committee. “I have not had people to support me to do the most basic human things, or things that make my life worth living. For the past three years, I’ve been existing, but not living. I’ve become like a plant. I may get water, but I receive very little sunshine to help me grow.”
Garcia said he has had three different supportive living agencies that gave him 30-day notices due to lack of staffing. Another apartment he was placed in had severe bed bugs. His mother is too elderly to give him the care he needs, and his father did not always show up to support him, he said.
“I went for days without seeing anyone. No food. No support to get dressed or bathed,” he said.
Garcia said wages and training for direct care workforce must be a high priority for the Legislature this upcoming year.
“Having well-qualified, well-paid direct care workers is the difference between my life as a plant, and me having a life,” Garcia said.
House Minority Leader Rep. Ilana Rubel, D-Boise, spoke after Garcia’s statement, tearfully saying, “I just wanted to say to Mr. Garcia and to those who have gone through your experience, I am so sorry. I am so sorry that we have been here on our end, sitting on a billion-plus dollar surplus every year, while you have been suffering and the Legislature has had the power to address your suffering and has not acted.”
State Independent Living Council executive director Mel Leviton shared the stories of two men with disabilities who were strong advocates against being placed in institutional settings, but because of their inability to find direct care workers were forced to move into nursing homes.
“It’s not about money. I realize everybody has a budget, we all have a budget and live within that budget, but we all have to decide what’s really a priority, too. It seems to me that lots of people in here ought to be a priority,” said Leviton, gesturing to the disabled people in the committee room.
Idaho Department of Health and Welfare Director Dave Jeppesen acknowledged that the state has increased the Medicaid reimbursement rates to home and community-based services in recent years. This allows for care worker pay increases. In Fiscal Year 2023, the Legislature gave IDHW $230 million for rate increases, and in FY 2024, the Legislature appropriated $25 million to IDHW for rates. In the pending budget request for FY 2025, the department asks for an additional $46 million.
“This is a very large problem. It’s going to take some time, and we are at the very beginning of solving the problem,” Jeppesen said.
The IDHW’s Division of Medicaid Administrator Juliet Charron also offered recommendations to the committee on the direct care workforce.
In Fiscal Year 2025, the Medicaid division plans to request 62 new staff positions, including care managers for developmental disability services, data analysts, contract monitoring, policy specialists and provider relations positions to respond more efficiently to provider inquiries. That budget request must still go before the Joint Finance-Appropriations Committee in the upcoming session.
The Division of Medicaid recommends forming the reimbursement rates for home and community-based services using multiple rate-setting processes. That would include cost surveys, provider rate reviews, and the weighted average hourly rate review.
Charron said they also recommend improving transparency in setting rates for users who use the self-directed model. The division also recommends lawmakers consider allowing the division to set region-specific rates.
Rep. Doug Pickett, R-Oakley, said he was concerned about the growing budget requests.
“I can’t help to look at the budget in comparison to the need and ask myself, ‘where does the money go?’” Pickett said. “This Medicaid budget is out of control, quite frankly, but the need is tremendous, and I ask myself, ‘why does the money not get to where it needs to be?’”
The legislature had made significant investments in home and community-based services over the last several years, Charron said, but direct care agencies are private businesses.
“While we reimburse providers and provider agencies, there is a limitation to how we can direct provider agencies to then reimburse staff,” she said. “They are hiring staff, they are deciding the wage at which to pay staff, they are doing recruitment and retention efforts.”
Charron told the committee her team is doing everything they can to help families and to support them, but that was another reason she needed additional staff.
“It all supports the care that we give,” she said.