THE PROVIDER RATE STUDY: WHAT IS IT & WHAT DID WE LEARN?

In 2021, Governor Gianforte authorized a comprehensive Medicaid rate study so the 2023 Legislature could make datainformed decisions on how much funding Developmental Disability Program (DDP) Providers require in rate increases to remain operational. A consulting firm, Guidehouse, collected reports on revenue sources, expenses, staffing ratios, overtime hours, nonreimbursable time, health insurance, benefits, and travel to determine what DDP Providers need in Medicaid rates to be sustainable. The data were compared to neighboring states, national data, and the Bureau of Labor Statistics. Guidehouse’s recommendations reflect what Home and Community Based Service providers require to maintain operational infrastructure and pay competitive wages to retain enough employees to meet the health and safety of Montanans receiving services. Results indicated that DDP providers need an average rate increase of 25.8% above current rates to be viable. Gov. Gianforte has proposed funding that would increase rates by only 36% of the amount recommended by Guidehouse over the next biennium. The final decision on funding rests with Montana legislators. The outcome of this decision impacts Montanans with disabilities who require direct support professionals in order to be healthy and live as independently as possible.

Patrick Maddison

CEO, Flathead Industries

President, MT Assoc. of Community Disability Services

CARE FOR MY SON MEANS I CAN WORK

Elizabeth Cummings, Parent Advocate, Educator

Every Saturday morning, I fill out time cards. Like many parents of children with special needs, my life is full of paperwork. But I don’t find the timecards tedious. Each week they’re completed means another week I found care for my sixteen-year-old with complex needs. It’s another week I got to work as a teacher and contribute to my community. It’s another week we made it. Finding care has never been easy. My son needs constant supervision and has a Medicaid waiver to help provide support. Services provided are diverse, including help to learn tasks that promote independence such as job skills and medication management. Finding qualified applicants to do this work has always been difficult, but inflation and rising costs of living have resulted in a workforce crisis in disability services. Families like mine, fortunate enough to receive a Medicaid waiver, have been allotted support hours – but too often there is simply no one to fill them. Between medical appointments, therapy sessions, case management and daily care logistics, having a child like mine can be a full-time job. This is even more true as a child grows older and school ends. Many families find themselves with no choice other than to have one parent step away from the workforce to assume these responsibilities. Too often families become less able to provide for their own financial security. Extraordinarily high turnover rates in disability services lead to a lack of consistency in care. Individuals with disabilities deserve consistent, quality support. Those doing this hard work deserve a competitive wage. A rate increase will help DSPs support their families, and help families like mine be stronger and more self-sufficient.

DSPs: THE REASON I CAN GET OUT OF BED & WORK

Bonnie Kelley, Self-advocate, Family Navigator

Without a Direct Support Professional (DSP), I am stuck in the same position I was placed in the night before. I cannot move. I cannot use the toilet. I cannot live. I was in a car accident 11 years ago. I have paraplegia and I am paralyzed from the waist down. I use a power wheelchair. It takes me three hours to get ready in the morning. That can’t happen without my DSP. They help me shower, eat and drink, dress, and so much more. If I am without a DSP in the morning, I am stuck in bed until 2 pm. I lose six hours of my day and miss work. If I am without a DSP in the evening, I must sleep in my chair. If a DSP quits, I have to beg friends who have other jobs and busy lives to cover shifts. If they can’t cover, I’m stuck. This happens frequently, usually when people find better pay. Every DSP I’ve had has held one to two jobs in addition to my care to make ends meet. The people working for me right now make more at their fast-food jobs than they do helping me. If I only had one DSP working all of my shifts, they would make a monthly wage of $2,136, before taxes. The average two-bedroom apartment in Missoula is $1,600 a month. A fast-food place can pay someone $17/hour to flip burgers, but the people I depend on to get out of bed get paid $13/hour. Anyone who claims to care about Montanans who are disabled should support giving DSPs better pay. We need to pay DSPs the wage they deserve.

LIFE, LIBERTY, & THE PURSUIT OF HAPPINESS

Darren Larson, Self-advocate, Customer Experience Analyst

I grew up in a small Montana town. My dad, a logger, and my mom, a stay-at-home parent, raised me with Montana values to work hard, respect those around you, and give back to your community. My upbringing was conventional. My life is not. I have cerebral palsy and use a wheelchair in my daily travels. Mom and dad did not treat me differently than my brother. I had chores to complete and was expected to do well in school. I graduated high school, then college, and obtained a job. Some people call it inspiring. I call it life. Over the years, hundreds of DSPs have come into my life. They help me with activities of daily living like bathing, dressing, eating, and transportation. I am truly blessed. I am no different than anyone else. I have hopes and dreams, and the will to act on them. I just need help doing so. My DSPs’ daily commitment to caregiving provides me access to and fulfillment of personhood. It keeps me safe, healthy, and on track to accomplish my goals. Imagine climbing a mountain, not by yourself, but with someone by your side. They support you and motivate you to take another step forward. Now your successes are not just your own, but successes you share with hundreds of caregivers who have come along your side, making it all possible. First, how cool is that? Second, what value would you place on that journey? Finally, per hour, what is that support worth? Caregiving needs to be treated as a valued and respected profession because caregivers provide everyday access to life, liberty, and the pursuit of happiness.

DSPs SUPPORT MY BROTHER’S HEALTH & HAPPINESS

PJ Rismon, Sibling Advocate

I am “big” sister and legal guardian of a 73-year-old man with developmental disabilities. Since birth, my brother has lived with cerebral palsy, total deafness, and intellectual and emotional deficits. He is a hero in my eyes, as he does not let his challenges keep him from thoroughly enjoying the good things life brings his way! My brother is unable to care for himself and lives in a group home for men with developmental disabilities. The Direct Support Professionals (DSPs) who care for him are an important piece of the support system that helps him live a safe and happy life. DSPs provide critical care for their clients in numerous ways:

• Monitoring and addressing clients’ physical and mental health conditions
• Accompanying and transporting clients to medical appointments as well as fun activities
• Ensuring proper medications are taken at correct times each day
• Preparing safe, nutritious meals in whatever form a client is able to consume them
• Assisting clients with daily hygiene needs
• Ensuring clients are safe and well cared for in the group home and in the community
• Helping clients stay engaged and involved in appropriate daily activities
• Providing friendship and companionship, including learning ways to meet special communication needs

My brother has needed more care than our family could provide since he was 19. Were his group home to close due to lack of funding or qualified staff, I, as his legal guardian and only family member, would be desperate to find a situation which could meet even part of his current needs. His service provider and group home staff are essential to his health and wellbeing.

THE WORK OF A DSP: HEAVY HEART, FULL HEART

A Direct Support Professional (DSP) is an underpaid and overworked professional who often feels unseen. Meanwhile, we care for your aunt’s personal needs because she is incapable of feeding, bathing, or changing herself. We comfort your son and use de-escalation techniques to calm him after he has been physically aggressive toward us. DSPs feed, bathe, toilet, comfort, clean, and prepare meals specific to dietary needs. We shop, attend doctor appointments, chart and track health/behavior, teach personal hygiene and daily living skills, and administer medications. We manage seizures, diabetes, and eating disorders. We advocate for the nonspeaking, wipe noses and other areas that need care, and clean up drool, vomit and soiled sheets – often in the middle of the night. We also cheer every achievement big and small with enthusiastic, heartfelt praise. We go on outings and defend our client’s feelings when someone is rude or acts like disability is contagious. We educate people, hoping they can accept our client as a member of the community – because they are a member of the community. We develop personal relationships with precious people we would otherwise never know. They need us. They become part of our lives. We become part of theirs. It is a physically and emotionally demanding job. A lot of shifts end with thoughts like: can I take much more of this? Then, I remember the smiles and little victories throughout the day. My heart is heavy and full. The job is tough, and many new DSPs don’t last long, but I seriously love my job and am proud to be a Direct Support Professional.

 

“Considering the fact that wages for DSPs have not tracked as closely to inflation over time as wages for other job types, and that DSP wages are closer to the minimum wage than wages for other job types, DSP wages are typically the most sensitive in the system both to changes in the labor market and to rising consumer costs.” (Montana Rate Study, page 31)

“Rate analysis suggests in-home services such as personal assistance/personal care and homemaker services, along with nursing and a few other services, would require 50-70 percent rate increases in order to keep up with growing labor costs.” (Montana Rate Study, page 125)

To share your thoughts about Direct Support Professionals or funding a provider rate increase with your state representative/senator, find their contact information online at leg.mt.gov/legislator-lookup

• Just click “view a map”
• Type in your address
• Click “find my district”
• Click your location on the map

This site also includes tips for communicating with your legislators.

Disclaimer:

This publication was developed under Grant H84MC32752 from the Health Resources and Services Administration (HRSA), Family to Family Health Information Center, $96,750. Views and opinions expressed in this article are the author’s and do not necessarily reflect the official policy or position of the Montana Family to Family Health Information Center, the Rural Institute for Inclusive Communities, the University of Montana, or HRSA.

Montana Voices Amplified:

The Montana Voices Amplified project offers people of all ages and abilities a stage to speak for themselves.  The series is hosted by the Montana Family to Family Health Information Center (MT F2F), a program of the Rural Institute for Inclusive Communities (RIIC) at the University of Montana.

Montana Voices Amplified provides a microphone and broad audience so the stories, lessons, causes, and advice of individuals with disabilities and their families are heard.

Montana Voices Amplified welcomes submissions of five-minute videos or 600-700-word essays on any topic related to your lived experience as a person with a disability or caring for someone with a disability.

Authors of chosen submissions receive $100. Videos will be posted on the MT F2F website and shared on social media. Essays will be posted on the website and ScholarWorks, shared on social media, and printed in a professionally designed publication to distribute to families, schools, agencies, and legislators as appropriate.

Let us amplify YOUR voice!

Send your idea for an article or brief video to stacey.bliss@mso.umt.edu or shawna.hanson@mso.umt.edu.

If you prefer to talk through your idea, you can call Shawna at (406) 243-4531 or Stacey at (406) 243-5760.