BREAKING NEWS! On November 22, a federal district court judge issued an injunction which effectively blocks implementation of the new DOL Overtime Exemption final rule indefinitely. For more information, click here. To read DOL’s statement on the litigation, click here.
Providers of vital community services to individuals with intellectual and developmental disabilities need help from Congress to keep their services stable in the face of changes to federal law and ongoing funding challenges at the state and federal level. Over time, the cost of providing services has risen while the federal and state funding on which these providers rely has stayed stagnant or even shrunk. This reality creates unintended hardships for the direct support workforce and the people they help lead full lives.
Understanding Who Needs Help:
Providers of community services offer intensive and critical services for individuals with intellectual and developmental disabilities. This includes helping individuals eat, bathe, take crucial medications, find or go to work, and generally be an active member of society. These services are offered within a community setting, allowing individuals to live with friends or peers in group homes, with their families, or in homes of their own with just the amount of help they want and need. Over 90 percent of funding comes from state and federal Medicaid dollars, which providers have no ability to negotiate. Unlike some other federal programs, the rates are fixed, and often do not cover the actual cost of services. As it stands, the funding is not enough to meet the community’s needs. Currently many states have waiting lists for these services – a situation that is likely to worsen as providers are facing increased costs without additional support.
Uncertainty Moving Forward:
Providers fully support raising the wages of the professionals who perform this difficult but essential work, but find it nearly impossible to recruit, train, and retain quality staff sufficient to meet the demand for services under current Medicaid funding levels.
In May 2016, the Department of Labor finalized a rule that would significantly increase the overtime exemption salary threshold for certain categories of employees. While well-intentioned, this rule, which did not address funding, would put an enormous strain on already overburdened providers. This rule is currently in a state of legal flux, having been temporarily blocked by a federal judge. Although the rule is temporarily suspended, the overarching challenges that providers face remain, and some form of the rule is likely to be implemented in the future.
In January 2014, the Centers for Medicare & Medicaid Services issued a final rule that sets forth requirements for individuals receiving home and community-based services (HCBS) funding. The overarching goal of the rule is to ensure that individuals are served in inclusive, community settings. States have until 2019 to fully transition into compliance. During the transition period, there are increased upfront costs for states and providers, which has not been fully addressed.
In October 2013, the Department of Labor finalized a rule that limits the use of the companionship exemption, for the first time prohibiting its use by third-party or joint employers, This has resulted in significant structural changes needing to be made by service providers, often by restricting overtime permitted to be worked by companions, which impacts continuity of care and quality for individuals served.
There is great uncertainty moving into a new administration and Congress how these regulations will be funded, as well as what changes may be made to the Medicaid program that providers rely on.
Congress Must Ensure that Vital Services Remain Funded:
In recent years, there have been budget proposals to block grant or instill per capita caps on Medicaid, which seek to obtain federal cost savings by shifting the costs of the program onto states. Congress must ensure that current federal funding levels remain stable, while increasing funding that will allow providers to provide quality services, and pay workers adequately.