Paying for Quality Care: State and Local Strategies for Improving Wages and Benefits for Personal Care Assistants

The United States is experiencing a severe shortage of qualified direct-care workers to provide personal care services (PCS), a shortage promising to increase as our country ages. Evidence from a growing number of studies reveals that wages and benefits paid to PCS workers play a fundamental role in determining the quality and quantity of these workers.

This AARP Public Policy Institute report by Dorie Seavey and Vera Salter of the Paraprofessional Healthcare Institute examines state and local initiatives for improving wages and benefits of direct-care workers delivering Medicaid personal care services. The report provides an in-depth analysis of state and local practices and reviews the pros and cons of seven strategies for enhancing PCS-worker wages and benefits.

Key issues developed in the report include:

• Lack of Federal Oversight and Guidance. Federal oversight of and guidance to state Medicaid rate-determination methods and procedures have been minimal.
  
  
• Existing Direction to States. Directions derived from court decisions and federal statutes and regulations are specified in the report.
  
  
• Ad Hoc Reimbursement Rate-Setting Methods. Most states set reimbursement rates for Medicaid PCS in a relatively ad hoc manner.
  
  
• Problematic Rate Setting. Most current approaches to PCS rate setting and wage determination are problematic (reasons cited in the report).
  
  
• No Single State Solution. Exemplary approaches to improving wage rates and benefits for PCS workers usually are unique to particular state contexts.

(44 pages)