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State legislation regarding wages and benefits of home care workers: Thirteen promising practices

Alice Wong, H. Stephen Kaye and Robert Newcomer

July 2007

Introduction/Background

The number of people in the United States that need personal assistance or home health services is steadily increasing with projections indicating the demand will double from 13 to 27 million by 2050 (Kaye et al., 2006: 1113). With the growing demand, the workforce that provides non-institutional personal assistance and home health services tripled between 1989 and 2004, going from 264,000 to 894,000. These data are based on monthly estimates of the personal assistance workforce from the Current Population Survey (Kaye et al., 2006: 1115). Recent data from the Current Population Survey report that the number PAS workers, adjusted for seasonality and survey change, has increased to approximately one million workers by 2007 (Kaye, 2007: 4). These trends are shown in the following graph.

Graph indicating increase in number of PAS workers over the period, 1989 to 2007

In spite of this growth in workers, a number of problems affect the personal assistance service workforce. Among these are low wages and benefits, high turnover rates, lack of training and advancement, and difficult working conditions (Newcomer and Scherzer, 2007: 6; Seavey and Salter, 2006: i).

Earnings data from the Current Population Survey show the median hourly wage for PAS workers compared with those of nursing home workers between 1989-2006. Home care worker wages increased 67% during this period, approximately keeping place with inflation. The hourly wage rate for nursing home workers increased to 89% during the same time period (Kaye, 2007: 11). Should such trends continue, the disparity between home and personal care workers and their counterparts in nursing homes and assisted living facilities will only widen. Further complicating matters, a recent ruling by the Supreme Court (Long Island Care at Home Ltd. v. Coke, U.S. Supreme Court Docket No. 06-593 2007) upheld the federal regulations that exempt home care workers from overtime pay and other minimum wage protections (Greenhouse, 2007). The question at the heart of the case was whether regulations from the Fair Labor Standards Act exempted home care aides employed by agencies from minimum wage and overtime protections. This exemption was upheld and applies to employees of home care companies of any size in addition to individuals who work directly for patients, residents and their families.

Graph indicating change in hourly wages for PAS Workers, Nursing Home Aides and Food Counter Workers over the period, 1989 to 2007

Wage differences also exist between the types of home care workers and between those in private agencies, state Medicaid personal care programs, or for private pay recipients. There is also wide variation in hourly rates by state and county (e.g., Maine Department of Health and Human Services, 2007; PHI, 2006; Sallee and Rosaen, 2006; BDO Seidman, 2005). According to data from the American Community Survey 2002-2005 (Kaye, 2007: 12), PAS worker hourly wages (including both agency or non-agency workers) ranged from $6.25 (e.g., Texas and West Virginia) to $14.24 (e.g., Delaware).

Picture indicating the hourly wage for PAS Workers by state

These survey-based wage rate data are consistent with those reported by the Bureau of Labor Statistics' National Compensation Survey of agencies employing personal care and service workers. Click BLS_home_health_aides.xls to download the Bureau of Labor Statistics' May 2006 Excel table for the occupation category. Click BLS_personal_care_workers.xls to download the Bureau of Labor Statistics' May 2006 Excel table for the occupation category.

The persistently low wages and substantial variation among states raises the question of what state-level factors may be contributing to this. Dorie Seavey and Vera Salter from PHI (and a collaborating partner with the PAS Center) began to study this question in their report, Paying for quality care: State and local strategies for improving wages and benefits for personal care assistants (2006). They identified seven strategies used by states, localities and advocates to improve the wages and benefits of direct-care workers:

Wage pass-through legislation
Rate enhancements linked to provider performance goals or targets
Reform of methods for rebasing and updating reimbursement rates for Medicaid HCBS
Litigation against state Medicaid agencies
Collective bargaining by direct-care workers
Living wage ordinances and minimum wage improvements
Health insurance initiatives targeting direct-care workers (Seavey and Salter, 2006: 7).

In this report we extend the Seavey and Salter work and focus on promising examples of state legislation seeking to specifically increase the hourly wages or benefits of home, direct or personal care workers. This does not include ballot measures passed in recently (e.g., Arizona, Missouri, Colorado, Montana, Ohio and Nevada) increasing the minimum wage in their states and annually adjusting them to offset inflation (CNN, 2006).

Thirteen bills or legislative appropriations meeting our criteria were found. These are deemed 'promising practices' because they were passed into law except for one bill, Maine LD 1687, that is still in session). These bills increase wages of home and personal care workers in a number of ways: increasing the Medicaid reimbursement rate (such as a living wage adjustment), amending current laws, or providing health insurance parity.

Methodology

These bills were identified from a systematic search of each state's legislative database. We looked for any bill introduced between 2001-2006 related to the topic of wages and benefits of home care workers (additional bills and legislative appropriation for 2007 are also included in our listing). Key terms, "home care," "personal care," "direct care," "nursing care," "frontline staff", "wages," "workforce," "benefits," "Medicaid," were used to capture bills for home care workers. To be included in the listing of bills, it had to focus on wages and benefits. Topics like retention, training, recruitment or other subjects related to this profession were excluded unless wage and benefits were also included. Contacting home care, disability, and health policy organizations at the national and state level augmented the search. From these groups we requested information about legislation (in the form of bills or appropriations) not previously found. We also conducted a literature review on the subject of home care wages and benefits (e.g., Salter and Wilner, 2006; Argiropolis, Nielsen and Ricker, 2006; Ebenstein, 2006; HCHCW, 2006; Howes, 2002). Click http://www.pascenter.org/publications/library.php?project=pas_workforce to find additional papers/reports found on this topic from the Center for Personal Assistance Services workforce library.

The initial search for bills and background research identified approximately 100 bills. Excluding bills that did not exclusively focus on increasing wages or benefits, the list was reduced to 38 bills from nineteen states as potential promising practices. Twenty-nine of these bills died in committee, did not progress any further during the legislative session or were vetoed and were no longer considered a promising practice bill (see the list of these bills in Appendix A). Of the 29 excluded bills, 21 were regarding wages for PAS workers, 5 regarding benefits and 3 regarding both wages and benefits. Four of the bills listed had companion bills in either the House or Senate. Companion bills were counted only once since the text was identical.

The final list of promising practices consists of 11 bills and 2 legislative appropriations (LA and WY). Nine of the promising practices emerged from the initial search and another 4 from subsequent research from other sources. For these thirteen bills and legislative appropriations, we continued to look for additional and updated information about the bill's history and current status from legislators.

Promising Practice Bills/Appropriations

Seven of the 13 bills or legislative appropriations considered 'promising practices' (AK, DC, LA, MI, NH, NY 2001-02,WY) increased wages for workers and six (ME, MA, MT, NY 2007-08, WA 2006, WA 2004) related to collective bargaining agreements/insurance coverage. Most of these bills did not dramatically increase the wages or benefits of home care workers. For example, Arkansas' Senate Bill 37 proposed to raise the hourly rate of Medicaid home care workers by 15 cents in 2003. On the high end, the District of Columbia (in their Budget Support Act of 2005) increased wages of their Medicaid home health care workers and personal care assistants to $10.50 per hour, an addition of $2.80 over their original rate. Two states, Louisiana and Wyoming, passed legislative appropriations specifically for direct-care workers substantially increasing their hourly wages (e.g., $2/hour wage pass-through from Louisiana). The appropriations from Louisiana and Wyoming were part of an effort to recruit and retain the direct care (a.k.a. direct support) workforce in their respective states. The bills from Massachusetts, Maine and New York (2007-08) provided direct care and home health workers access to their state health insurance program; only the bill from Washington (2006) enhanced the benefits of agency home care workers by providing parity in worker's compensation contribution rates with independent providers. The following is a brief on each the thirteen bills and legislative appropriations. Full copies of the bills are available to download.

Arkansas 2003 - "An act to amend the Arkansas Revenue Stabilization law, and for other purposes," Senate Bill 37

Medicaid home care workers in Arkansas earned a starting salary of $5.60 in 2000 (SEIU, n.d.). An amendment was added to the Revenue Stabilization Act that increased the hourly rate for Medicaid home care workers by 15 cents starting July 2004 (SEIU, n.d.). Senate Bill 37, The Revenue Stabilization Act, passed and became Act 55 on May 13, 2003. Click AR_SB37.pdf to download the full text of Senate Bill 37.

District of Columbia 2005 - "An act in the Council of the District of Columbia, Fiscal Year 2006 Budget Support Act of 2005," Bill #16-0200.

Funds were appropriated for Medicaid personal care workers and home health aides as part of the DC budget for fiscal year 2006 (Bill number B16-0200, 2005). This act allocated $6 million for living wage increase to Medicaid home health care workers and personal care assistants at a minimum of $10.50 per hour. This raised the hourly rate by $2.80. Further, any home health care agency or personal care service provider organization failing to meet the "minimum wage requirement" may become ineligible for Medicaid funds (Salter and Seavey, 2006: 8-9). Click DC_Budget_Support_Act_of_2005.pdf to download the full text of the D.C. Budget Support Act of 2005.

Louisiana 2007 - "Wage pass-through for direct care workers.

A news release from the Louisiana Department of Health and Hospitals announced an increase in wages for direct care workers (DHH, 2007). The wage increase received legislative and budgetary approval and took effect on February 9, 2007. Because it was an "emergency rule," it appeared in the February 2007 issue of emergency rules in the Office of the State Register instead of having a specific bill number. In Louisiana, agencies "are given the authority through R.S. 49:953.B to adopt temporary rules or emergency provisions that respond to "... an imminent peril to the public health, safety, or welfare" (OSR, 2007). The $2/hour wage pass-through from this action will result in Medicaid-funded direct care workers earning at least $6.65/hour (Their, 2007). Louisiana policymakers hope this wage increase will improve the retention and reduce the shortage of direct care workers in the wake of Hurricane Katrina. Click dsp_wage_summary.pdf for a summary of the wage pass-through from Louisiana Citizens for Action Now. Click 0702emr.pdf for the full text of the emergency rule containing the wage pass-through on p. 30.

Maine 2007 - "An act to increase health insurance coverage for front-line direct care workers providing long-term care," LD 1687

This bill amends the definition of "eligible business" for the Dirigo Health Program (the state's program providing health coverage for the uninsured). The amendment allows providers of long-term care services with more than 50 employees to enroll in the Dirigo Choice health insurance plan (Maine State Democrats, 2007). The bill also prioritizes direct care workers for enrollment in the health plan and requires the Department of Health and Human Services to provide financial assistance to long-term care providers to start or expand health care coverage for their direct care employees. The bill also requires the Department of Health and Human Services to design a plan that allows employers to contribute monthly premiums for their employees enrolled in the health plan. As of June 21, 2007, the Maine legislature website reported the bill is carried over to any special or regular session of the 123rd legislature pursuant to Joint Order HP 1369. Click Maine_LD_1687.pdf to download the full text of LD 1687.

Massachusetts 2005, "An act establishing the direct care workers insurance assistance program," Senate Bill 705

Senate Bill 705, "An act establishing the direct care workers insurance assistance program," originally pertained only to direct-care workers, but it was amended and subsumed into a broader bill that became Ch. 58 of the Acts of 2006, "An act providing access to affordable, quality, accountable health care." Ch. 58 of the Acts of 2006 provides near-universal health insurance for all Massachusetts residents. The law creates a Health Care Quality and Cost Council that will set quality improvement and cost containment goals for Massachusetts. The Council will collect cost, price and quality data from health care providers, pharmacies, payers and insurers. The Council will develop and maintain a web site with cost and quality information about providers for consumers and purchasers (Massachusetts State Legislature, 2006). Click MA_S_705.pdf to download the full text of original Senate Bill 705. Click MA_Ch_58_2006.pdf to download the full text of Ch. 58 of the Acts of 2006.

Montana 2007 - "Health insurance incentives for Medicaid healthcare workers," [short title] Senate Bill 206.

Passed by the legislature and signed by the Governor on May 16, 2007, Senate Bill 206 would require the Department of Public Health and Human Services to conduct a study to determine the feasibility, impact and cost of providing employer-sponsored health insurance to personal-care attendants and direct-care employees of organizations that receive a majority of their revenue as a result of providing Medicaid-funded long-term care services by increasing certain Medicaid payments to their employers and requiring the increased payments be used to fund the health insurance, authorizing a pilot program and requiring a report to the Legislature. "The proposed pilot program would insure nearly 2,000 Montanans for about $2.9 million in state funds, which would draw an additional $6 million in matching federal funds," explained Mike Hanshew, policy director for Montana Health Solutions, LLC (Christensen, 2007). The bill would be effective on passage and approval and terminate Jan. 1, 2009. Click MT_SB_0206.pdf to download the full text of Senate Bill 206.

Michigan 2006 - "An act to make appropriations for the Department of Community Health and certain state purposes related to mental health, public health, and medical services for the fiscal year ending September 30, 2007; to provide for the expenditure of those appropriations; to create funds; to require and provide for reports; to prescribe the powers and duties of certain local and state agencies and departments; and to provide for disposition of fees and other income received by the various state agencies," Senate Bill 1083.

The State of Michigan approved a budget measure in 2006 that increases the wages of home care workers from $6.07 to $7.00 per hour. Senate Bill 1083 recommends an estimated $31.5 million for the increase in wages as part of the budget for the Department of Community Health (Office of the State Budget, 2006). This pay increase will go home care workers in the Home Help program, the state's largest and oldest in-home services program (SEIU, 2006). Approximately 42,000 caregivers who work in the Home Help program will benefit from the wage increase (SEIU, 2006). Another Michigan bill, Senate Bill 318, changed the minimum wage of all workers. The Governor signed the budget on March 28, 2006 with the intent to gradually increase the minimum wage from $6.95 beginning October 1, 2006, to $7.15 beginning July 1, 2007, to $7.40 beginning July 1, 2008 (Senate Bill 318, 2006). The Governor approved Senate Bill 1083 on August 10, 2006. Click MI_SB_1083.pdf to download the full text of Senate Bill 1083.

New Hampshire 2006 - "An act making an appropriation to the Department of Health and Human Services for home care providers," House Bill 1710.

The State of New Hampshire passed a similar bill to Michigan's Senate Bill 1083. It appropriated $457, 802 to the Department of Health and Human Services to fund the 2007 cost of rate increases for home care providers and services implemented during fiscal year 2006 (House Bill 1710, 2006). Another $719,895 was appropriated to the Department of Health and Human Services for a 4.6 percent rate increase for home care providers and services in the fiscal year 2007. This is in addition to the rate increases implemented during fiscal year 2006 (House Bill 1710, 2006). This bill was a technical correction bill to provide increases to providers inadvertently excluded from the state's budget (Steve J. Mosher, personal communication, February 6, 2007). The Medicaid reimbursement rate for personal care services prior to July 1, 2005 was $16.00/hour and increased by 4.6 percent on July 1, 2005 and again on July 1, 2006 (Steve J. Mosher, personal communication, February 6, 2007). New Hampshire reimburses providers for services to Medicaid clients and individual providers establish their own wage rates and benefit levels for workers providing the services (Steve J. Mosher, personal communication, February 6, 2007). Click NH_HB_1710.pdf to download the full text of House Bill 1710.

New York 2007-08 - "An act to amend the social services law and the state finance law, in relation to Medicaid payment rates and health insurance for personal care services and employer and labor partnerships for Family Health Plus," Assembly Bill 5919B/Senate Bill 6344.

Passed by the New York State Assembly, Assembly Bill 5919B (with identical bill S6344) was signed the Governor on July 4, 2007. This bill will allow employers of home attendants and home health aides and Taft-Hartley funds (union-employer benefit funds) to buy into Family Health Plus, a state-sponsored insurance program (HCHCW, 2007). Medicaid reimbursement rates will be adjusted in four counties that will be earmarked for health insurance coverage for home attendants and home health aides (HCHCW, 2007). With the passage of this bill, approximately 40,000 home health aides and home attendants will have access to health insurance (HCHCW, 2007). Click NY_A5919B.pdf to download the full text of Assembly Bill 5919B.

New York 2001-02 - "Relates to the Health Care Reform Act of 2000," [short title] Senate Bill 6084/Assembly Bill 9610.

On January 2002, Governor George Pataki signed S 6084, also known as the Health Care Workforce Recruitment and Retention Act (Trunzo, 2002). This initiative was funded as part of the NY Health Care Reform Act to address the shortage of health care workers in New York State by infusing new funds for workforce recruitment and retention (Trunzo, 2002). According to the National Clearinghouse on the Direct Care Workforce, this program was funded for 3 years and $1.8 billion of the total $3.5 billion applied to increases in wages and other training and retention initiatives. Of the $1.8 billion for wages, 38% went to hospitals, 27% to nursing homes, and 34% to personal care (NCDCW, 2007). The wages per hour increased approximately $1.35 on top of the existing 2002 wage with some portion of that increase earmarked for the home care workers' health insurance plan with the union SEIU local 1199 (NCDCW, 2007). The Health Care Workforce Recruitment and Retention Act was enacted as Chapter 1 of the Laws of 2002 (organized in 3 parts: A, B and C). Later that year, Chapter 82 of the Laws of 2002 contained some amendments to the act in parts J and K (Andrew C. Fogarty, personal communication, July 16, 2007). To read the text of Senate Bill 6084, click Chapter_1.pdf to download Chapter 1 of the Laws of 2002. Click Chapter_82.pdf to download Chapter 82 of the Laws of 2002.

Washington 2006 - "An act relating to parity for home care agency workers; adding a new section to chapter 74.39A RCW; creating a new section; providing an effective date; providing an expiration date," Substitute House Bill 2333.

This act is specifically focused on providing parity for both independent provider and agency-based home care workers. The bill was signed into law on March 7, 2006 (Substitute House Bill 2333, 2006). Currently, independent providers of home care in Washington have collective bargaining rights while agency providers are reimbursed via vendors. Independent providers of home care services received an increase of hourly wage rate from $9.20 to $9.45 in fiscal year 2007. Agency providers of home care services received an increase in provider rates from $15.28 per hour to $15.59 per hour in fiscal year 2007. This act mandates "the Department of Social and Health Services (DSHS) to establish a formula to convert the cost of worker's compensation increases negotiated and funded by individual providers of home care services into an hour amount that will be added to the statewide agency home care provider vendor rate" (Substitute House Bill 2333, 2006). DSHS also has to provide the same contribution rate for health care benefits for agency providers of home care services that are negotiated by independent providers of home care services. Click WA_SHB_2333.pdf to download the full text of Substitute House Bill 2333.

Washington 2004 - "An act relating to implementing the collective bargaining agreement between the home care quality authority and individual home care providers; creating a new section; making appropriations; and declaring an emergency," Engrossed House Bill 1777.

On October 2004, the HCQA (Home Care Quality Authority), the agency of the state government that provides oversight of home care services and acts as the "employer" of individual home care providers, and the bargaining representatives of the individual home care providers renegotiated a contract that increased wages and provided worker's compensation benefits. Engrossed House Bill 1777 provides approximately $48.8 million to implement the renegotiated collective bargaining agreement between the HCQA and the bargaining representative of the individual home care providers (Final bill report, 2004: 2). Click WA_EHB_1777.pdf to download Engrossed House Bill 1777.

Wyoming 2002 - "Wage increase for Direct Service Professionals, Enrolled Act No. 43, Chapter 83, Agency 048, Footnote 7, of the State of Wyoming 2002 Special Session.

In 2001 Wyoming's Developmental Disabilities Division submitted a study to the Department of Health Joint Appropriations Committee. It reported that the average hourly wages for direct support professionals (DSPs) ranged from $6.79-$8.37 (Seavey and Salter, 2006: 8). The study recommended a $10.23 per hour entry wage level with increases for more experienced workers (Seavey and Salter, 2006: 8). In 2002 the Wyoming legislature passed an appropriation increasing DSP wages to $7.50 per hour and up to $10.32 for DSPs with 12 months experience (Seavey and Salter, 2006: 8). The 2002 appropriation was $7,607,540 in general funds and $14,767,578 in federal funds in order to raise the salaries of direct care personnel in adult developmental disability community-based programs (Sherard, 2002). Click WY_Act_43.pdf to download Enrolled Act No. 43, Chapter 83, Agency 048, Footnote 7, of the State of Wyoming 2002 Special Session. Click WY_2005_Wage.pdf to download the report by Lynch, R.M., Fortune, J., Mikesell, C.E., and Walling, T.L. (October, 2005). Wyoming demonstrates major improvements in retention by enhancing wages and training, Links, 35, 9, 9-10. Click WY_2002.pdf to read the report from the Wyoming Department of Health to the Joint Appropriation Committee on the Impact of Funding for the Direct Staff Salary Increases in Adult Developmental Disabilities Community-Based Programs.

Conclusion

If you are aware of a recently passed bill that you consider a promising practice in PAS workforce wages and benefits, contact Alice Wong, Staff Research Associate, Center for Personal Assistance Services: alice.wong2@ucsf.edu, 415-502-7097.

Appendix A: Wage & Benefit Bills Introduced 2001-2006, But Did Not Become Law
State/Year	Bill Number/Bill Title	Description or Excerpt from Bill Text	Last Known Status of Bill
Arkansas 2001	HB 2161 An act to make an appropriation for state match for a reimbursement rate increase for Medicaid in-home care services for the Department of Human Services-Division of Medical Services for the biennial period ending June 30, 2003; and for other purposes.	"Section 1. Appropriations-State matching funds-Medicaid In-Home Care. There is hereby appropriated, to the Department of Human Services - Division of Medical Services, to be payable from the General Improvement Fund or its successor fund or fund accounts, the following: (A) For state matching funds for an increase in the reimbursement rate for Medicaid In-Home Care services from $12.36 per hour to $13.85 per hour to give low wage in-home service workers a wage increase, for each fiscal year of the biennial period ending June 30, 2003, the sum of ..........$2,500,000."	May 14, 2001 Died in House committee.
California 2006	SB 1660 An act to amend Section 12306.1 of the Welfare and Institutions Code, relating to public social services.	"SB 1660, Romero. In-Home Supportive Services: provider wage and benefit increases...Existing law establishes a formula with regard to provider wage or benefit increases negotiated or agreed to by a public authority or nonprofit consortium, and specifies the percentages required to be paid by the state and counties, beginning with the 2000 - "01 fiscal year, with regard to the nonfederal share of any increases. Under existing law, each of these increases becomes operative under the condition that the May Revision forecast of General Fund revenue for a fiscal year, excluding transfers, exceeds by at least 5%, the most current estimate of revenues, excluding transfers, for the year in which the previous increase became operative. This bill would eliminate the condition necessary for an increase in the nonfederal share of provider wages and benefits to become operative, for the 2006 - "07 fiscal year and each fiscal year thereafter."	October 2006 Vetoed by Governor.
California 2006	AB 2536 An act to amend Sections 500 and 510 of, and to add Section 1194.3 to, the Labor Code, relating to employment.	"Existing law, with certain exceptions, establishes 8 hours as a day's work and a 40-hour workweek, and requires payment of prescribed overtime compensation for additional hours worked. A violation of this provision is a misdemeanor. This bill would provide that these overtime compensation requirements shall apply, with certain exceptions, to a personal attendant, as defined. By imposing additional requirements on employers, the violation of which would be a misdemeanor the bill would impose a state-mandated local program."	October 2006 Vetoed by Governor.
Connecticut 2006	SB 5722 An act providing funds to the Office of Policy and Management for rate adjustments.	"Sec. 2. (Effective July 1, 2006) In accordance with the provisions of section 17b-340 of the 2006 supplement to the general statutes, the Office of Policy and Management shall adjust the rates of facilities that can demonstrate that Medicaid does not fully reimburse the reasonable costs mandated by collective bargaining when the facility is staffed at the actual state-wide average hours per patient, for all direct and indirect costs. Priority shall be given to facilities that are engaged in collectively bargaining an initial contract. For the purposes of this section, "direct costs" means nursing costs; and "indirect costs" means housekeeping, dietary, laundry, maintenance and rehabilitative costs."	February 13, 2006 Public hearing scheduled.
Connecticut 2005	CB 88 An act concerning rates paid by the Commissioner of Social Services for personal care assistance services.	To increase the maximum allowable rate paid by the Department of Social Services for personal care assistance services so as to promote the use of such services as a cost-effective alternative to long-term care.	February 8, 2005 Public hearing scheduled.
Maryland 2005	SB 986 and HB 1566 (identical bills) An act concerning Maryland Home Care Services-Personal Care Providers-Reimbursement, Training and Benefits	Requiring the Department of Health and Mental Hygiene to reimburse personal care providers specified amounts for personal care services provided under the Maryland Medical Assistance Program; requiring the Department to develop a specified training program for personal care providers that provide services under the Program; requiring the Department, in consultation with representatives of a public institution of higher education in the State, to develop and implement a curriculum for the training program on or before July 1, 2006; etc.	March 10, 2005 Re-referred to Finance committee (favorable with amendment report by Finance committee in April 2005).
Massachusetts 2005-06	HB 3756 An act to provide a living wage to all employees of providers that deliver social services or child care under contract or subcontract with the Commonwealth.	Provides a living wage of $12.89 per hour ($11.89 if health insurance is included) to all employees of providers that deliver social services or child care under contract or subcontract with the state.	January 26, 2005 Referred to the Committee on Labor And Workforce Development (study ordered by the House in February 2006).
New Hampshire 2003	HB 793-FN-A An act relative to reimbursement rates for home health services and making an appropriation therefore.	"I. The Commissioner of Health and Human Services shall establish as unit Medicaid reimbursement rates for home health service rates that would exist had annual adjustments been made, beginning October 1, 1999 and then each October 1 thereafter, proportionate to any changes in the federal home health market basket index. II. The Commissioner of Health and Human Services shall annually, on October 1, adjust the Medicaid reimbursement rates for home health services proportionate to any change in the federal home health market basket index."	January 5, 2004 Inexpedient to legislate.
New Jersey 2006-07	A2496 and S1953 (identical bills) A supplement to "An Act making appropriations for the support of the State Government and the several public purposes for the fiscal year ending June 30, 2006 and regulating the disbursement thereof, " approved July 2, 2005 (P.L.2005, c.132).	Supplemental appropriation of $14 million in State and federal funds to increase reimbursement to providers of personal care services by $1.50 per hour. Also, the legislation would increase the maximum hourly weekend rate by $1.50, from $16.00 to $17.50.	February 9, 2006 Introduced, referred to Assembly Human Services Committee.
New Jersey 2004-05	A4555 A supplement to "An Act making appropriations for the support of the State Government and the several public purposes for the fiscal year ending June 30, 2006 and regulating the disbursement thereof," approved July 2, 2005 (P.L.2005, c.132).	Supplemental appropriation of $14 million in State and federal funds to increase reimbursement to providers of personal care services by $1.50 per hour. Also, the legislation would increase the maximum hourly weekend rate by $1.50, from $16.00 to $17.50.	January 5, 2006 Introduced, referred to Assembly Health and Human Services Committee.
New Jersey 2002-03	A709 and S580 (identical bills) An act concerning Medicaid reimbursement for home health care services.	"Dignity in Home Care Act"; provides for increases in Medicaid reimbursement to home health agencies for direct care worker salaries; appropriates $10 million in State and $10 million in federal funds.	January 8, 2002 Introduced, referred to Assembly Health and Human Services Committee.
New Mexico 2006	SB 734 An act making an appropriation to increase Medicaid reimbursement for nursing facilities and intermediate care facilities for the mentally retarded.	"Section 1. Appropriation - " Ten million dollars ($10,000,000) is appropriated from the general fund to the human services department for expenditure in fiscal year 2007 to increase the Medicaid reimbursement rate for nursing facilities and intermediate care facilities for the mentally retarded to maintain competitive wages, adequate staffing and local minimum wage requirements."	Bill died (date not given).
New Mexico 2002	SB 242 An act making an appropriation for staff support for nursing facilities throughout New Mexico.	"Section 1. Appropriation - " Four million dollars ($4,000,000) is appropriated from the general fund to the human services department for expenditure in fiscal year 2003 for the purpose of providing funds for the recruitment, retention, salary enhancement and fringe benefits of direct care providers in licensed nursing homes throughout New Mexico."	Bill died (date not given).
New York 2006	A08695 and S5583 (identical bills) An act to amend the social services law and chapter 1 of the laws of 2002, amending the public health law, the social services law and the tax law relating to the Health Care Reform Act of 2000, in relation to the living wage adjustment of personal care services workers.	Relates to the living wage adjustment of personal care service workers; authorizes the commissioner to adjust personal care services medical assistance rates of payment for personal care service providers; provides for such adjustments to be subject to subsequent adjustment or reconciliation in accordance with the local living wage law or are located within a city with a population of over one million persons which has enacted a local living wage law that applies to such persons; defines local living wage law.	January 24, 2006 Referred to Ways and Means committee.
North Carolina 2005-06	HB 119 A bill to be entitled an act to appropriate funds for labor enhancement payments for nurse aides in noninstitutional settings, as recommended by the North Carolina Study Commission on Aging.	"SECTION 1. There is appropriated from the General Fund to the Department of Health and Human Services the sum of fifty one million five hundred eighty three thousand seven hundred twenty four dollars ($51,583,724) for the 2005 2006 fiscal year and the sum of sixty one million eight hundred sixty six thousand five hundred eighty nine dollars ($61,866,589) for the 2006 2007 fiscal year. These funds shall be used to match federal Medicaid funds to provide a thirty two and seven hundredths percent (32.07%) labor enhancement payment for Medicaid reimbursed long term care services. These funds shall be in addition to funds provided for routine inflationary increases in Medicaid reimbursements for long term care services. The funds appropriated in this act shall be used only to increase wages or benefits for long term care aide workers in noninstitutional settings, or to provide for shift differential payments for long term care aides in noninstitutional settings who work during hard to fill working hours or shifts. Counties shall not be required to pay any of the funds required to match the federal Medicaid funds for the labor enhancement payments authorized by this act."	April 5, 2005 Referred to committee on appropriations.
North Carolina 2005-06	SB 1648 A bill to be entitled an act to appropriate funds to increase the Medicaid rate for Personal Care Services.	"SECTION 1. The Department of Health and Human Services shall increase the Medicaid PCS (Personal Care Services) rate for low-income seniors in Alzheimer's Special Care units effective July 1, 2006. SECTION 2. There is appropriated from the General Fund to the Department of Health and Human Services, Division of Medical Assistance, the sum of eight hundred fifty thousand dollars ($850,000) for the 2006-2007 fiscal year. These funds shall be used to increase the Medicaid PCS rate as provided in Section 1 of this act. SECTION 3. This act becomes effective July 1, 2006."	May 18, 2006 Referred to Committee on Appropriations/Base Budget.
North Carolina 2003-04	SB 205 An act to appropriate funds for labor enhancement payments for nurse aides in noninstitutional settings.	"SECTION 1. There is appropriated from the General Fund to the Department of Health and Human Services the sum of twenty-eight million five hundred eighty thousand three hundred three dollars ($28,580,303) for the 2003-2004 fiscal year and the sum of fifty-seven million seven hundred twenty-four thousand three hundred twenty dollars ($57,724,320) for the 2004-2005 fiscal year. These funds shall be used to match federal Medicaid funds to provide a thirty-two and seven hundredths percent (32.07%) labor enhancement payment for Medicaid-reimbursed long-term care services. These funds shall be in addition to funds provided for routine inflationary increases in Medicaid reimbursements for long-term care services. The funds appropriated in this act shall be used only to increase wages or benefits for long-term care aide workers in noninstitutional settings, or to provide for shift differential payments for long-term care aides in noninstitutional settings who work during hard-to-fill working hours or shifts. Counties shall not be required to pay any of the funds required to match the federal Medicaid funds for the labor enhancement payments authorized by this act."	February 26, 2003 Referred to Committee on Appropriations/Base Budget.
North Carolina 2001-02	SB 180 A bill to be entitled to an act to appropriate funds for labor enhancement payments for workers in long-term care facilities and agencies.	"SECTION 1.(a) There is appropriated from the General Fund to the Department of Health and Human Services the sum of seventeen million six hundred seventy thousand nine hundred seventy-five dollars ($17,670,975) for the 2001 2002 fiscal year and the sum of twenty three million four hundred sixty thousand, seven hundred thirteen dollars ($23,460,713) for the 2002 2003 fiscal year. These funds shall be used to match federal Medicaid funds to provide a ten percent (10%) labor enhancement payment for Medicaid reimbursed long term care services. These funds shall be in addition to funds provided for routine inflationary increases in Medicaid reimbursements for long term care services. The funds appropriated in this section shall be used only to increase wages or benefits for long term care aide workers, or to provide for shift differential payments for long term care aides who work during hard to fill working hours or shifts."	February 19, 2001 Referred to Committee on Appropriations/Base Budget.
Oregon 2005	HB 3371 A bill for an act relating to workers' compensation coverage for home care workers; amending ORS 656.039.	Requires Home Care Commission to elect workers' compensation coverage for certain home care workers.	August 5, 2005 In committee upon adjournment.
Oregon 2003	SB 877 A bill for an act relating to unemployment insurance for individuals performing in-home care services; creating new provisions; and amending ORS 657.040.	Requires that individual who performs in-home care services be considered independent contractor for purposes of unemployment insurance laws.	August 27, 2003 In committee upon adjournment.
Oregon 2003	HB 3599 Relating to human services direct care employees; creating new provisions; amending ORS 427.340, 427.345 and 430.180; and appropriating money.	Directs Department of Human Services to require in agreements for mental health and developmental disabilities services that direct care employees receive wages and benefits at level no less than those provided to state employees performing comparable work. Directs state to sell real property known as Fairview Training Center. Requires deposit of proceeds from sale in Mental Health and Developmental Disability Services Account for use in providing direct care employee wages and benefits.	August 27, 2003 In committee upon adjournment.
Pennsylvania 2003	SB 74 An act establishing a minimum annual wage for certain full-time direct care employees of publicly funded mental health and mental retardation programs; and making an appropriation.	As a condition for receipt of public funds, publicly funded programs or agencies shall certify that all direct care workers are paid based on a minimum entry-level annual wage of $18,000 or $8.65 per hour. A percentage increase for the wages of direct care workers to raise the annual wage based on an entry-level wage of $18,000 per year or $8.65 per hour shall be funded from the annual appropriation to the Department of Public Welfare to fund community services for persons diagnosed as having mental illness and mental retardation. The increases for direct care workers shall be in addition to any increases that are attributable to other factors, including general cost-of-living increases for community services. The department shall receive certification from the provider agency that any increase under this section shall be utilized in its entirety to provide wage increases to direct care workers.	Jan. 27, 2003 Referred to Public Health and Welfare committee.
Washington 2005-2006	SB 6054 An Act relating to worker's compensation parity for agency home care workers	Provides that, for purposes of providing cost- efficient worker's compensation coverage for agency in-home caregivers, the department shall assume responsibility for providing worker's compensation coverage for employees of nonprofit and proprietary agencies who provide in-home personal care services pursuant to contracts with area agencies on aging. The worker's compensation coverage shall be provided on the same terms as the independent provider worker's compensation program.	January 9, 2006 By resolution, reintroduced and retained in present status.
Washington 2003-2004	HB 3204 Allowing basic health plan benefits for home care agency providers.	A "home care agency enrollee" category of Basic Health Plan (BHP) enrollee is established, defined as any employee of a home care agency licensed by the Department of Health and under contract with Department of Social and Health Services (DSHS) to provide home care services to elderly and disabled clients. Enrollment in the BHP is available to agency home care providers only to the extent that specific funding is provided for that purpose. Home care agency enrollee employee co-premiums for BHP benefits are set at the lowest premium paid by subsidized enrollees in the BHP. In 2004, this premium is $17 per month. Home care agency employer premiums are set at the amount the Health Care Authority (HCA) is charged by contract with a managed care plan, less the enrollee premium, plus the administrative cost of providing the plan to home care agency enrollees.	March 3, 2004 Returned to House Rules Committee.
Washington 2001-02	HB 1637 Enhancing the wages and benefits of long-term care paraprofessional workers providing care to the elderly and disabled.	The Department of Social and Health Services (DSHS) is directed to establish a wage enhancement program to raise the wages of both current and potential long-term care paraprofessional workers by an across the board $1 in the year 2001 and an average of $1 in 2002.	Jan 14, 2002 By resolution, reintroduced and retained in present status.
Washington 2001-02	SB 5821 Providing a wage increase for direct care workers in long-term care service.	Compensation for all unlicensed direct care workers who provide state funded long-term care in any long-term care setting, including homes, whose hourly wage is $9 or less per hour as of June 30, 2001, receive $1 per hour increase starting July 1, 2001. Compensation for all unlicensed direct care workers who provide state funded long-term care in services for the developmentally disabled, whose hourly wage is $9 or less per hour as of June 30, 2001, receive a $1 per hour increase starting July 1, 2001.	Jan 14, 2002 By resolution, reintroduced and retained in present status.
Washington 2001-02	SB 6079 Increasing the wages of long-term nonlicensed direct care workers.	Declares an intent to ensure that all nonlicensed direct care providers who are paid by the state, or private agencies contracting with the state, to provide direct care to vulnerable adults shall be paid an hourly salary that equals two times the minimum wage.	Jan 14, 2002 By resolution, reintroduced and retained in present status.
Wisconsin 2005-06	AB 771 An act to amend 20.003 (4) (fm) and 20.003 (4) (fr) of the statutes; relating to: required general fund statutory balance, required general fund structural balance, increasing nursing home Medical Assistance reimbursement, and making appropriations.	This bill increases the state general purpose revenue appropriation by $5,141,700 for fiscal year 2005-06 and by $10,118,000 for fiscal year 2006-07 to provide a 1.4 percent increase in each fiscal year to the nursing home MA reimbursement rate. Under the bill, nursing homes that receive the additional reimbursement must expend at least 50 percent of the amount received for increased payment for direct care wages, fringe benefits, or hours for nursing home staff.	May 11, 2006 Failed to pass pursuant to Senate Joint Resolution 1.

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