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Elderly, Disabled Fight Pay Cut to Service Providers

Advocates for the elderly and disabled are fighting a proposal in the Legislature that they say would reduce the wages of the personal care attendants who provide services through the Medicaid Community-Based Alternatives waiver program.

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Advocates for the elderly and disabled are fighting a proposal in the Legislature that they say would reduce the wages of the personal care attendants who provide services through the Medicaid Community-Based Alternatives waiver program. While the proposal was cut out of one bill Tuesday, the same language exists in a number of other bills, including the Senate version of the budget. 

The program is meant to provide an alternative for those who qualify through Medicaid for care in a nursing facility. Instead of living in an institution, those in the program get to live at home with the help of attendants who provide a range of services from minor assistance with housekeeping and preparing meals to help with showering, dressing and getting around. The program can pay for up to several hours of assistance a week.

But some advocates are worried by a proposal that would require those who participate in the program to access the services through a similar, but less expensive, state plan. The services to the patient would stay the same and it would save the state $28 million, but it would mean a significant pay cut for those whose job it is to provide those services, opponents say.

Currently that pay is around $8 per hour, but opponents to the change say going through the state plan would bring that pay down to the minimum wage of $7.25 an hour.

“We believe that would cause extreme crisis in the work force,” said Dennis Borel, executive director of the Coalition of Texans with Disabilities. Borel said the disabled and elderly who qualify for the program rely on the services the personal care attendants provide to stay out of nursing homes and continue living independently. The pay cut could mean higher employee turnover or fewer workers and potentially unreliable service that could then force people in search of dependable care into nursing homes.

But Sen. Jane Nelson, R-Flower Mound, author of Senate Bill 222, counters that going through the state plans first will be better for those who need attendant care and will allow the state to serve more people currently on the waiting list for these services.

“This service delivery plan will increase access to attendant care for the elderly and Texans with disabilities by more efficiently utilizing available service delivery options," Nelson said.

Nelson’s office added that the state currently pays different reimbursement rates for the same type of attendant care services. Requiring individuals to go through the state program would allow the state to continue serving those who receive services. Her office also said that federal officials have indicated they will soon require this type of service delivery plan.

The proposal was cut out of SB 222 on Tuesday at a committee hearing — a small victory for Borel, who said one of his organization's goals this legislative session was to increase pay for these attendant care providers.

But the same proposal is in two other bills and in the Senate version of the budget.

Borel argues that not only could it force more people into nursing homes, but it could also cost taxpayers more in the long run. The cost to the state to keep someone in a nursing home can be twice what it is through the waiver program.

“We are attacking a program that is a bargain to the taxpayers of Texas,” Borel said. 

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