An ACA Program Taps New Labor and Permanent Matching Funds
The Accountable Care Act (ACA) provides states a powerful yet little-utilized solution for stemming labor shortages in home care for the nation’s elderly and disabled. Like Uber, which accessed a new labor supply for transportation, ”Community First Choice” (CFC) opens up a new labor pool for attendant care that previously was restricted to home health aides.
CFC, also known as 1915(k), allows Medicaid beneficiaries to select attendants from individuals they know in their communities rather than being restricted to traditional agencies. In so doing, CFC provides access to a nearly limitless labor pool for a market that is already tight even before the coming seniors boom.
A Home Labor Crisis
For many states, this opportunity represents a solution to rapidly growing demand that in many markets has already outstripped supply. A recent study from the research and advocacy group PHI shows that while 740,000 new home attendant positions will be added over the next decade, nearly four times this number will leave the industry – either due to retirement or departure to work in another field.
CFC allows lay attendants to be hired and trained to perform Activities of Daily Living or Instrumental Activities of Daily Living (ADLs and IADLs) – support formerly sourced through home health agencies. States that require these activities be provided by certified skilled aides may need to waive local nurse practice acts. The use of non-certified attendants is well-tested in states like California where these services have been provided by lay providers for many years.
Permanent Federal Funding
States that add Personal Attendant Services (PAS) to their Medicaid State Plan benefits package receive a permanent six percent enhancement of federal matching funds, providing a strong incentive for adoption. Only eight states have adopted the CFC program so far, with four more having filed federal applications or actively considering it. For other states, this represents a ripe opportunity – not only as CFC solves a serious labor supply problem but also provides compelling financial and client experience advantages as well.
The State of Colorado retained The Innova Group for CFC program benchmarking, design, and financial impacts modeling. The consultants identified $30 million in annual financial benefit to the State – a more than 6 percent advantage over current waiver program attendant budgets. This did not include additional savings related to the state’s Nurse Home Visitor program, where attendants could be trained to provide care now performed by registered nurses.
The Power to Choose
Another benefit of CFC is the program encourages clients to direct their own care, enabling the selection, hire and firing of staff. This represents a significant advancement for person-centered care. Colorado already allows parents of disabled children to provide some attendant services in its children’s waiver program. CFC would expand this concept to adults, allowing them to hire friends, neighbors, and other community members. This gives clients increased control as well as improved care continuity from agency-sourced care, where staff turnover can exceed 67 percent per year according to a recent national study.
CFC may represent a triple win for states looking to address labor shortages while leveraging budget and simultaneously improving the client experience. Even in states that took a cautious approach to ACA program expansion, this opportunity may be too attractive to pass up.
Jim Vogel is a Principal in the Denver office of The Innova Group, a U.S. consulting group providing policy and economic modeling to public and private health care organizations around the world. He can be reached at 303-263-4050.