Home Care Providers Face Perfect Storm in 2024

Denver, Colo. –  Several key challenges face home care providers heading into the 2024 Colorado legislative session, which begins Wednesday, Jan. 10. While there is no shortage of demand for home care services, there are unfunded mandates that continue to multiply, chronically deficient state funding, and barriers to patient access and provider certification.

“Home care in Colorado faces several challenges, and without prompt, decisive action from the state, it’s unclear how vulnerable Coloradans will continue to weather the storm,” said Don Knox, executive director of the Home Care and Hospice Association of Colorado. “Some patients already can’t access services; that problem will only multiply if the state fails to act.”

Unreimbursed minimum wage increase poses challenge
Knox is referring in part to the state’s Medicaid reimbursement rates, particularly in light of Colorado’s minimum wage increase policies. The state minimum wage adjusts annually for cost of living increases, and state law helped create a patchwork of local government minimum wage mandates. 

While many businesses have some latitude to pass increased costs along to consumers, Medicaid providers lack that flexibility. The payment rate, or reimbursement rate, for their services is set annually by the state. Despite the fact that state and local minimum wage increases go into effect in January, any approved payment increases for Medicaid providers typically don’t go into effect until six months later in July.

“The way the state sets Medicaid funding for home care services doesn’t account for local minimum wage increases in a timely manner,” said Knox. “Without addressing the six-month lag in payments, home care agencies are the ones left holding the bag.”

Addressing the private duty nursing shortage
The Home Care and Hospice Association of Colorado (HHAC), which represents home care agencies, is also concerned this year about the state’s low reimbursement rate for private duty nurses (PDNs). While these skilled workers make significantly more than minimum wage, the state-set reimbursement rates for PDNs are too low for Colorado to attract enough PDNs to work in home care.

“Even though home-based care is preferable for most eligible patients and their families – particularly when children are involved – there is a heartbreaking lack of private duty nurses to meet the need in Colorado,” said Knox. “When these families can’t get the services they need, it’s often the parents, grandparents and siblings who end up carrying the full load. It’s not a sustainable situation for long periods of time, and unfortunately many of these patients end up being admitted to an institution.”

The cost to the state of funding the same PDN services in a hospital or other clinical setting is considerably more than the cost of providing those services in the home.

Medicaid redeterminations create serious barrier to access
In addition to lagging Medicaid reimbursement rates, the state is redetermining Coloradans’ eligibility for Medicaid, a process that is creating barriers to access across the state, even for Medicaid-eligible patients. 

“I don’t think anyone could have expected that Medicaid redeterminations in Colorado would have such a disastrous impact on families who are still eligible for Medicaid,” Knox said. “Medicaid redetermination was not supposed to end or change services for families who still qualify, but that is exactly what’s happening. It’s a mess.”  

HHAC has received feedback from numerous agencies across the state about patients who have lost Medicaid services due to the redetermination process even though they still meet the state’s eligibility criteria. Many of those patients have had services restored, but many others are still working through the appeals process.

Caregivers face testing backlog
People wanting to become certified nursing assistants are facing delays due to a backlog in skills exams. Some people face months-long waits to take the skills exam; others have driven hours to take the exam, only to have it canceled on short notice. 

“With so many people unable to obtain CNA certification, it has been devastating for patients, families and the workforce,” said Knox. “Allowing the problem with testing access to go unaddressed would be irresponsible.” 

HHAC will advocate for the state to address these policy issues when the Colorado Legislature convenes this week.

The Home Care and Hospice Association of Colorado (HHAC) is a nonprofit representing home health, home care and hospice agencies statewide caring for tens of thousands of Coloradans, including elderly, disabled and blind individuals. Founded in 1970, the association is comprised of agencies of all sizes that provide a wide range of home-based services. They serve Coloradans in all 64 counties.