Maine Direct Care Worker Advocates Make Progress on Improving DCW Wages, Health Coverage

Helen Hanson

Here in Maine, we’ve been working on two bills that offer big possibilities for direct care workers, one by expanding health care coverage and the other by improving wages. A third bill, which would revamp the way long-term care is delivered, could also raise wages for home care workers.

Improving health care coverage

The health insurance bill, LD 1059, would set up a pilot program here based on what Montana did for its direct care workers. (pdf) The Maine Direct Care Worker Coalition (DCWC), which I’m a member of, developed the bill’s title and purpose and found a sponsor to introduce it in the legislature, but we never did come up with specific language.

What Montana did was secure an enhanced Medicaid reimbursement for agencies that provide health insurance for their workers. (Imagine that!) The money goes directly to the workers in the form of health insurance. It does not stay at the top as perks for the administrators, nor does it come down as health care fairs (or fluff, as I like to call them) where workers learn how to take better care of themselves. I think we all know how to do that.

Montana’s plan was implemented this past January. Last I knew, 900 workers had gotten health care coverage as a result — a small step in the right direction.

Here in Maine, LD 1059 came out of the Revisor’s Office before the DCWC was able to put language to the bill. The Revisor’s Office directed the Maine Bureau of Insurance to come up with a pilot using Medicaid money.

We had a meeting with Maine’s Speaker of the House, Hannah Pingree, in early March. Several of us workers were there, and we told Speaker Pingree about what we do and what it is like living with no health benefits from our work.

From this meeting, we were able to get another meeting with Speaker Pingree in late March. This second meeting was very important in that we finally got Department of Health and Human Services (DHHS) Commissioner Brenda Harvey; Trish Riley, the governor’s health policy expert; and Superintendent of Insurance Mila Kofman at the table with us, along with several other representatives who are strong supporters of this workforce. We managed to gain some support from DHHS at that meeting. Folks who have been working on this a lot longer than I have said this is the closest we’ve ever gotten.

The other thing that came out of that meeting was that Commissioner Harvey let us know Medicaid will not fund pilot projects. Superintendent Kofman told us the bill should be directed at DHHS, not Insurance and Financial Services, because of the Medicaid funding. We also learned that the bill’s hearing was the following week.

At a work session on the bill two days after its hearing, Geoff Greene from DHHS told the Insurance and Financial Services Committee that his department was “strongly supportive” of the bill and wants to look into the Montana Plan further. Since DHHS cannot draw down a Medicaid match for a pilot, he said, the department will need to work with the Centers for Medicare and Medicaid Services. He asked for time to look into this.

The Insurance and Financial Services Committee voted unanimously to carry LD 1059 over to the next legislative session – another small but significant victory in this ongoing battle. I say significant because the bill is not dead: The committee could have very easily voted it “ought not to pass” and left us back at the drawing board.

The DCA has been my main support in getting the health insurance bill introduced and keeping it alive. The Kennebec Valley Organization and Joyce Gagnon from Maine PASA have also been a great help, and the good people at PHI’s Health Care for Health Care Workers initiative, especially Allison Lee, have been a tremendous help for me in understanding how Medicaid works

The DCWC is tracking the process closely, to make sure the committee sticks to its word. I plan to be in on whatever action the DCWC takes with keeping DHHS to task and holding them accountable, whatever form it may take.

 Improving wages

The second bill is LD 1364, which would increase workers’ hourly wage to $12 an hour.

I am involved in this one through my union, MSEA-SEIU. While I was in DC with the Direct Care Alliance, this bill was having its public hearing in the Health and Human Services Committee. A colleague and former co-worker of mine gave my testimony.

It came out of the committee with a vote to hold it over to the next legislative session. The DCWC hasn’t been involved with it yet, but I intend to bring this up at the coalition meeting next month.

Combining the two

After talking with folks involved with LD 1364, I got to thinking that 1059 and 1364 may be competing for the same funding. There is discussion around both of a 2 for 1 match, with Medicaid contributing $2 for every $1 Maine puts into them. The problem is, Maine does not have the $1 to begin with.

So I started wondering if it made sense to combine the two bills. At 1364’s work session in the Health and Human Services Committee, the senate chair, Senator Brannigan, mentioned this same exact thing. I was surprised at his comment. It’s rare that a politician thinks the way I do!

Transitioning from nursing homes to home care

The third bill is LD 1078.

This one is huge. Again, I am involved in this one through my union. I haven’t done as much with it as with the others, so I’m not as clear on the details yet.

As I understand it, 1078 would shift funding from nursing home care to home based care and gives Maine’s consumers of long-term care more control over the kind of care they receive. It would also combine the 40 or 50 agencies now in Maine into just five or so to reduce administrative costs, saving money that would go to support a raise in pay for home care workers.

It sounds to me as if home workers would have more work and better pay if this bill goes through, while many of the administrative staff at Maine’s agencies would not.

This bill will also better define who is eligible for nursing home care versus home based care, refining Medicaid’s assessment guidelines for nursing home care, so people who do not need 24-hour nursing home care but do need some support can get the help they need at home.

This bill came out of the HHS Committee with many revisions and was signed by Governor Baldacci on June 8. I’ve contacted its sponsor, Representative Matt Peterson, for his insight into the revisions. He told me he’d rather do that in person than through email or over the phone, so we’ll be talking soon.

I heard that a report is due back to the legislature next year. To me, that sounds like they plan to just do another study instead of actually listening to the people who already testified at the hearing, saying nobody wants to end up in a nursing home.

We’ll have to see how it all plays out.

Helen Hanson
Home care worker