Home Health & Hospice Week

If states build nursing registries, will workers come?

Government officials, seniors, and providers of home care all seem to agree on one thing — keeping folks in their homes with state-provided home and community-based services is a great idea. But two major obstacles stand in the way: funding and staffing.

The American Rescue Plan Act passed in 2021 has made strides on the first front, and is trying to tackle the second, according to recent indications from the Biden administration.

Reminder: President Biden initially called for $400 billion in additional HCBS funding, then $150 billion, in his Build Back Better proposal, notes the National Association for Home Care & Hospice.

ARPA “provided qualifying states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for home and community-based services (HCBS),” the Centers for Medicare & Medicaid Services notes in a new recap of state spending under the law. It requires states to use state funds “to implement or supplement activities to enhance, expand, or strengthen Medicaid HCBS. CMS expects states to expend these funds by March 31, 2025,” the agency reviews.

“Nationally, over seven million seniors and individuals with disabilities and their families rely on home and community-based services (HCBS) to help meet their long-term care needs in their home or community, rather than in institutions or other isolated settings,” notes a White House fact sheet on the topic.

“The Biden-Harris Administration has distributed $37 billion from the American Rescue Plan across all 50 states for home- and community-based services,” Health and Human Services Sec. Xavier Becerra notes in a recent CMS release on the matter. “Additionally, we are delivering new guidance to states about how direct worker registries can help ensure more individuals receiving Medicaid-covered services can receive care in a setting of their choice.”

“It’s critical that people, particularly older Americans and people with disabilities, are able to receive care in the setting of their choice,” CMS Administrator Chiquita Brooks-LaSure says in the release. “To achieve that vision, communities need clear links to the qualified professionals best trained provide that care. Helping states build and maintain worker registries will enable more people to find and receive high-quality, affordable, and person-centered care at home and in the community.”

One state that has used its ARPA funds to power a registry is Wisconsin, the White House points out in the fact sheet.

Participants complete a free, 30-hour online course at their own pace and take a proctored exam before being listed, reports Wisconsin Public Radio. It includes a workforce portal, allowing certified workers to see available jobs and post resume information for potential employers. The state program also pays sign-on and retention bonuses for people who complete the program, WPR says.

Nearly 5,000 people have registered for the training and 218 people have completed it, with 157 of them currently employed in the field, the network adds.

“To keep people in their own homes is much less expensive than an institution, and the more important part is that’s where people want to live,” the state’s Kevin Coughlin told WPR. “If you can support that, along with saving money, that’s a win-win.”

States have also used ARPA funding to boost staff recruitment and retention through pay raises, bonuses, etc.; improved training programs; and reduced HCBS wait lists by opening up new spots, among other initiatives, CMS says in its review. States have also used the funds for electronic visit verification (EVV).

HRSA Grants Chip Away At Nurse Shortage

Another route for ARPA funds is through the HHS Health Resources and Services Administration. In Maine, HRSA is furnishing a grant for Eastern Maine Community College and local hospitals to provide satellite training to nurses in rural areas, reports The Observer newspaper.

“Often, if nursing education isn’t offered close by or isn’t easily accessible, people will take a different path,” says Heather Rushmore, with EMCC’s Nursing program. “Through this grant and our continuing relationship with Eastern Maine Community College, we can bring that education to people living in these regions who want to pursue nursing,” Rushmore says, according to the Observer.

Another example: A $6.5 million HRSA grant is also funding the University of Louisville’s new accelerated Licensed Practical Nurse-to-Bachelor of Science in Nursing (LPN-to-BSN) pathway in medically underserved areas of Kentucky, the university says in a release. “These kinds of workforce pipeline grants are truly transformative and will make a lasting and tangible impact on the health and wellness of Kentuckians for generations to come,” Interim Provost Gerry Bradley says in the release.

In its latest poll of HCBS wait lists, KFF reports that about 0.7 million Americans are on such lists in 38 states. Of those, about a quarter are seniors and people with disabilities.

“Waiting lists may reflect both shortages of workers and insufficient state funds,” KFF notes. “Although states reported increasing provider payment rates and other efforts to bolster the workforce, challenges remain and some of states’ policies for addressing those challenges have ended with the conclusion of pandemic-era programs,” the health news outlet adds.

Ahead: “It remains to be seen how policy changes enacted during the pandemic will affect the provision of HCBS in future years and whether the investments in HCBS through the American Rescue Plan Act will result in capacity increases even after the federal funding ends,” KFF concludes.