No one begrudges paying those on the front lines of personal care $19 an hour, but no one seems to know where the money will come from.

State lawmakers are advancing new legislation to ensure better pay for all homecare assistants serving Medicaid clients, a longtime goal supporters thought they had already achieved, but learned would not be fully funded under Gov. Phil Murphy’s budget proposal.

The Senate Health, Human Services and Senior Citizens Committee voted Monday to advance the measure championed by Sen. Troy Singleton (D-Burlington) to ensure the state’s Medicaid plan pays $19 an hour for all personal care services — nonmedical assistance from licensed professionals who help some 22,000 disabled and elderly New Jerseyans with dressing, cooking, and daily living tasks that are often essential to allowing them to remain independent at home.

Most of these workers are paid closer to $15 an hour, with some earning as little as $10, making it hard for care agencies to attract and retain staff. Homecare and hospice agencies, as well as elder advocates, supported the bill.

Senate health committee chairman Joseph Vitale (D-Middlesex) praised Singleton’s work on the issue, since the sponsor himself was not there for the vote. “Sen. Singleton fought for a long time to make sure those who provided these services on the ground every day get the kind of pay they deserve,” Vitale said.

While the bill itself received little attention, pay for these personal care assistants was a major concern among members of the Assembly budget committee, who raised the issue repeatedly during a hearing last week on the state Department of Human Services’ spending plan for fiscal year 2019, which begins in July.

Assemblyman John Burzichelli (D-Gloucester) stressed that PCA wages had also become a sticking point during last year’s budget standoff with former Gov. Chris Christie, which led to a multiday shutdown of state government.

No money for the measure

But regardless of support for the bill, the Murphy administration has suggested the state doesn’t have funding to cover its share of the increase. Even Burzichelli said at the budget hearing that there was not a “strong appetite” to raise taxes, so even a relatively small cost could prove challenging to fund.

“It’s just a struggle: all good causes, never enough money,” he said.

The issue dates back to early 2015, when lawmakers — led by Singleton (a former Assemblyman) and Sen. Loretta Weinberg (D-Bergen) — began to advance a bipartisan plan to boost wages for these workers. Last summer they passed a bill calling for all PCAs to be reimbursed at a uniform rate based on what the state already paid through it’s fee-for-service system, negotiated at $19 per hour. It also required all increases in pay go into the workers’ pockets, not go to the homecare agency that employs them.

While about 5 percent of Medicaid clients are part of fee-for-service systems, in which providers are paid for each treatment at the $19 negotiated rate, the vast majority are enrolled in managed-care plans overseen by HMOs. These contracts call for reimbursements of only $15.50 an hour, which meant these workers earned $3.50 less for the same tasks.

The federal contribution

A 2016 fiscal estimate for the legislation predicted that, with more than 6.6 million hours of care billed to Medicaid, it would cost at least $25 million more to bring all workers up to the $19 level, at least half of which could be recovered from the federal government.

Christie signed that bill in October and added $20 million in extra funding to the budget for the current fiscal year, which runs through June, to cover these additional costs. But the Murphy administration did not include this funding in its own $37.4 billion fiscal 2019 plan, released earlier this year, and without a permanent revenue source, these payments could essentially become one-time bonus’ for the workers involved.

DHS Commissioner Carole Johnson, who oversees Medicaid, praised the work of these front-line workers during the recent budget hearing and noted that the Murphy administration was hoping to identify a more long-term solution to improving their pay. The department’s budget includes $14.4 billion for the Medicaid, or FamilyCare program, including $10 billion in federal dollars. This involves an increase of about $244 million, of which some $16.7 million will be used to increase wages for PCAs.

But Johnson said that $16.7 million, which will generate a federal match of the same amount, will still only allow the DHS to reimburse the majority of primary-care services at $16 an hour — three dollars short of the goal. Fully funding a $19 hourly wage for all PCAs would cost another $50 million, she said, at least half of it from state sources.

Singleton’s new bill (S-1820), which is also backed by Declan O’Scanlon Jr. (R-Monmouth), would address this disparity by establishing in writing a $19 minimum hourly wage for all PCA workers. (The current law requires all providers to be paid at the higher fee-for-service rate, but doesn’t set a dollar amount.) It also requires that any increase go into the workers’ pockets, minus administrative costs for the agency.

An Assembly version awaits a hearing.

Original Article