*This blog is a transcript of a previously hosted webinar. Since the content is still relevant, we wanted to share it in a blog post in case it can help you too!

To read the first blog in this series, check it out here .

Marki Flannery: Nancy, can you please comment on the percentage increase that New Jersey just received from the state for Medicaid for homecare workers reimbursements?

Nancy Fitterer: It’s a long daily struggle and we talk to the state often. One of the things that we talk about is, “We have our workforce shortage, but also for the workforce that we do have, Medicaid reimbursements are really low, and that only adds to the shortage.” A couple of years ago, when New Jersey created their minimum wage standard, and minimum wage was going to go up every year by $1 until it hit $15, one of the things that we were really concerned about is: as minimum wage goes up, while it’s something that we applaud, and we want to have happen, it is going to have a negative effect on our Medicaid workforce unless Medicaid continues to add the appropriate money to the program. So, they have given us $1 increase every year as Medicaid has gone up.

But the problem is, and COVID exacerbated this, folks were afraid to go into people’s homes during COVID. You walk outside your house right now and go anywhere, there are help wanted signs everywhere. So, as Amazon builds larger warehouses in New Jersey, as more people are looking for a workforce, that really just shrinks our workforce in all levels, not just the Medicaid population, but at all levels. 

If you can get paid $18 to work at Amazon, you may not want to work as a home care aide. So, one of the things that the association has struggled with, and has repeatedly advocated for, is to make sure that, as much as humanly possible, our Medicaid reimbursement stays in line with minimum wage and stays in line with inflation and how expensive things are.

In New Jersey, our personal care assistant rate is currently at $23 in our reimbursement for the provider, which is higher than in many other states, although New Jersey is a really expensive place to live in. So, it’s higher than some of our neighboring states, but it’s constantly going back to the state and being a real partner with them. We had them go through this whole process where they reviewed how many referrals weren’t being taken by any provider, because there just wasn’t any staff and it put more on us on the managed care plans to really figure it out. 

Either they were going to start giving more money or something to the providers to make sure that patients were serviced. One of the big things the Association does is advocate every year with the governor’s office and the legislature to make sure that we get an appropriate rate reimbursement. So right now, we’re advocating that the rate should go from $23 to $25 an hour, the governor’s office went to $24 and we’ve got budget resolution in to make it $25. 

Hopefully, it gets passed in the budget and the reimbursement rate, to providers, not necessarily to the aides themselves, would be $25. On the private duty nursing side, we’re asking that the rate also be increased because again, it’s not just a home care aide crisis. It’s a nurse crisis as well, and we’ve spent a lot of time advocating for higher reimbursement rates.

Michael Gelman: Nancy, I think you used Jeff Bezos and Amazon as a good example. Jeff Bezos, regardless how you feel about him, has a famous quote that says, “When you’re in a tight box, the easiest way to get out of it is to innovate your way out,” right? “Invent your way out.” 

That’s who we’re competing against right now – these global companies that spend all their time thinking about how to get that box to you faster. It’s about logistics and workforce, and that’s who’s taking the market away from us right now. It’s important for us, as an industry, to innovate as hard as these big tech companies are innovating, so that we can compete.

Marki Flannery: Gigo, I have a question for you. I heard that you were pleased to see that CareConnect works seamlessly with HHAeXchange. So, can you share an example of how that partnership was beneficial to your organization?

Gigo George: So, as we mentioned earlier, there has always been a gap between the caregivers and the systems that we use, and we need to improve the process and communication with the caregivers. When we first saw the introduction to CareConnect, we saw some amazing features that they have, which we haven’t seen with other providers, because some of the software out there has so many advanced features, but nothing really works. Especially when it comes to the home care industry, especially with the utilization of software by the caregivers, and also by the agency coordinators or the nurses.

So, the shift booking process: CareConnect is seamless with the HHAeXchange system itself, which is widely used by all departments of our organization – everybody uses HHAeXchange. So, having that option, without going to different systems, and having that feature to directly connect with the caregivers, actually helps the coordination team in working a bit more efficiently. They can communicate directly to the caregivers, instead of doing lots of manual reports, making a phone call and sending a text message by going into different systems and logging into multiple systems. 

We have been looking for a solution where the caregivers don’t have to go outside of the system itself, and can connect and use one system. We already have a challenge with the caregivers not being able to use it, because sometimes it doesn’t work or sometimes it has support issues. That’s where we need to have one solution where they can log in and get the job done; whatever reporting that they have to do, whatever the communication that needs to happen, is happening within the system. 

So, CareConnect has whatever features we need to complete the InServices online. You can send notifications directly to the caregivers who are actually tending to do the InServices online, without them being non-compliant, and we don’t have to wait that long. We can actually get it done on time. That kind of efficient process, which we have been looking for, and that actually helps, especially with the seamless integration with HHAeXchange, too; we don’t have to switch into a whole new system or go through a whole new training process for the entire team, which was something very attractive for us.

Marki Flannery: Thank you. I’m going to go to John next. So, John, any thoughts that you have or anything you’d like to add to what Gigo just said related to the relationship between CareConnect and HHAeXchange?

John Pandolfi: So, first of all, as a company, there’s been a shift in mindset – we build software that supports the home care industry, but it’s not just the providers we’re supporting. We’ve shifted our mentality; everything we try to do and think about deals with, “How does the end result impact the caregiver?” Everything coming out of Gigo’s mouth is about that “in-the-field worker,” people delivering the care – that’s where technology matters. So, Gigo, you should know, we really have had a major shift in our mentality about how we approach developing software.

In terms of how HHAeXchange works with CareConnect, I think we’ve also changed our mentality, in that we cannot build everything all at once. So, when we cannot build all the things, we partner with the technology folks that are building the things that we wish we had in our platform, or they do things super well. Things that CareConnect does, we can’t invest in the present time to do, so we built a super- tight integration with them that allows our providers with the core foundational elements of a patient- caregiver visit to expand to CareConnect’s platform and provide more efficiency and value. So, there’s a point in time where you have this hubris that you can develop everything all at once, but the reality is that technologies and the market change so quickly that you have to find partners that service the same industry, and work really well with them. So that’s been our mentality, and we really foster that relationship.

Michael Gelman: We appreciate it.

Marki Flannery: Thank you. Question from the chat: is there any progress with the rate increases in the state of Florida? We are facing a similar minimum wage, and you will increase on top of the current costs of living, rapidly increasing. Does anyone have any knowledge to that effect?

Nancy Fitterer: I don’t. Bobby Lolley has my job in Florida. Bobby is really well known and respected. So, Bobby would be the best person to ask that – you can always just email him. I’m sure he is working on it, but I don’t have any specifics.

Michael Gelman: Nancy, these funds, is there an allocation that’s part of the ARPA funding? Or are they coming from a separate source?

Nancy Fitterer: So, it’s complicated. The federal government gives each state a specific amount. So, New Jersey gets a 50/50 split: New Jersey pays 50%, the state pays 50%. Each state is different. There were some FMAP funds during COVID, so all states were increased 10%. States were given federal funds to be used for a variety of reasons. I know New York just announced spending lots of ARPA funds in great ways to help healthcare; New Jersey hasn’t done that. But again, it would be specific to the state. 

So, Florida may be doing something with their ARPA funds, but I don’t know. Usually, the funds are given to the states and then they decide what to do. Whether it be childcare, whether it be infrastructure, whatever it is. 

There’s usually parameters that have to be given. Every state applied to CMS to get a certain amount of money and have a plan. So, New Jersey had a plan; it increased the personal care system rate from $22 (that was in the budget last year) to $23, which is why the rate is $23 now. But, there was some workforce retention that they wanted to spend money on. The personal preference program received a big increase. 

It really just depends on the state’s initiatives – it doesn’t mean that every state did the same thing with it. Originally, 6.2% was given, but states weren’t required to enhance programs. They can basically just take the money and put it in their coffers. So, when the 10% was given, it was, “No, you have to actually do something that you’re not doing before. Give more money to a program – you can’t just kind of put it in your state coffers.” So that’s when they had to come up with a plan and then it went to CMS.

About The Experts:

Gigo George: Gigo has been with Sunshine Homecare for over six years. He’s a highly skilled and accomplished operations manager, project manager, and IT professional working within a matrix structure and helping to change the paradigm of project management from a cost center to a value-added role. He holds a Master’s degree in Healthcare Information Systems from Binghamton University, and an MBA from Mahatma Gandhi University with a focus on Information Systems Marketing, and Project and Brands Management. 

Michael Gelman: Mike is the President and Chief Operations Officer at CareConnect. He is a financial and corporate development executive with over 20 years of experience in senior roles at institutionally-backed healthcare and technology companies. He brings a wealth of experience to help CareConnect provide services to you, the homecare provider.

Nancy Fitterer: President and Chief Executive Officer at Home Care and Hospice Association of New Jersey. Nancy has been heading the Home Care and Hospice Association of New Jersey for almost four years. Prior to joining that organization, she served as Chief of Staff to two New Jersey Attorney Generals. Nancy also served in various other capacities during her eight-year tenure in the Office of the Attorney General, including Chief of Staff of the Division of Consumer Affairs. Nancy was also Chief of Staff for Senator Jennifer Beck and Assemblyman Declan O’Scanlon, a trusted policy adviser to the New Jersey Assembly Republican Office, and a constituent relations advocate to New Jersey Governors, DeFrancesco and Whitman. She is a graduate of both College of New Jersey with a Bachelor of Arts in Political Science and Seton Hall University with a Masters in International Relations and Diplomacy.

John Pandolfi: He is Vice President of Client Success with HHAeXchange, where John works to ensure all home health agency customers are receiving maximum value from their software solution and achieving their goals. John joined HHAeXchange in March of 2017 as a project manager and transitioned to the client success team shortly after. He’s worked with numerous home care agencies to boost their workflow efficiency and improve care for their patients. He is committed to using excellent communication transparency, thoughtful strategy, and problem solving to help HHAeXchange clients successfully grow their business. Prior to HHAeXchange, John worked as a senior consultant in the State and Local Government Solutions Division for CGI, a global information technology consulting and solutions company. John holds a BA in economics from Providence College.