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Increased wages for PCAs core of proposed rate framework changes

A diving accident in 1974 left Tim Benjamin a quadriplegic. He can’t use his hands or legs and a respiratory problem makes it impossible to clear his own throat.

But with the support of personal care assistants, he’s been able to live independently, get his education, marry, and advocate for other people with disabilities while working full-time – currently as a columnist at Access Press.

But the average PCA only makes $12.35 an hour. Some work multiple jobs, but remain on the edge of poverty, and high turnover reduces the quality of care provided while creating instability in the lives of vulnerable people, said Rep. Todd Lippert (DFL-Northfield).

He sponsors HF663, which would adjust the rate framework used for reimbursing PCA services and implement program integrity measures. This should increase wages, making becoming and staying a PCA a viable option for people, Lippert said.

The House Human Services Finance and Policy Committee laid the bill over Friday for possible omnibus bill inclusion after amending it to make technical changes and fill in component values of the proposed rate framework, among other changes.

A companion, SF497, is sponsored by Sen. Paul Utke (R-Park Rapids) and awaits action by the Senate Human Services Reform Finance and Policy Committee.

“For Minnesota to be a state that works for everyone, we need to ensure that people with disabilities and older adults can access the care they need,” Lippert said. “This is a matter of human dignity, and sometimes, it’s a matter of life and death”

Proposed changes to the rate framework would use a cost-based, data-driven system to determine reimbursement rates for PCA services, Lippert said.

They include requirements to:

  • draw on current wage data from the U.S. Bureau of Labor Statistics to determine base wage component values;
  • incorporate a competitive workforce factor looking at other, comparable jobs;
  • consider non-wage factors like paid time off and training;
  • be updated every two years;
  • undergo ongoing evaluations of whether the component values “appropriately address” the cost of providing services; and
  • collect cost data from agencies enrolled to provide services at the rates determined by the bill.

These changes would cost the state about $290 million a year, beginning in fiscal year 2023, and impact the lives of nearly 100,000 people, including people dependent on PCA services and the PCAs themselves, Lippert said.

“It’ll benefit some of the most vulnerable Minnesotans while valuing workers who are offering essential care and deserve a living wage for their efforts, their compassion, and their skill,” he said.

While providing PCA care is costly, it’s still cheaper than the alternative: inferior care in congregate care facilities, testifiers said.

“By not having PCA support, I am unable to be the productive citizen I’ve always been proud of being,” Benjamin said.

Without higher reimbursement rates, smaller agencies – including those that provide specialized, culturally competent services to minority communities – will continue to close, and the PCA program could collapse altogether, said Pang Vang, owner of Rainbow Health Kare and treasurer of the Minnesota First Provider Alliance.

The bill would also require a study of direct care workers providing PCA services and their use of public assistance programs, with a report due to the Legislature by Oct. 1, 2023.

An amendment offered, and then withdrawn, by Rep. Mohamud Noor (DFL-Mpls), would have temporarily increased the reimbursement rate between the fall of 2021 and the effective date, providing more immediate relief.

“I want people to understand we’ve got a lot of work to do,” Noor said.

Changes would apply to both the state’s personal care assistance program and the community first services and supports program – which the personal care assistance program is transitioning into this fall, said Kristy Graume, legislative director for the Department of Human Services’ Community Supports Administration.

“There are a lot of similarities … the CFSS program offers more self-directed options. It also allows for reimbursement for parents of minors and spouses to provide those services,” Graume said. “The rates are the same, and will transition to same rate no matter what it is.”

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