Like many states, Texas is struggling to attract and retain home health workers to care for people with intellectual and developmental disabilities, a crisis that has swelled amid the pandemic and after years of low wages.
So when state health officials announced last summer that they planned to use federal pandemic money for one-time bonuses, it seemed like relief was on the horizon for a few hundred thousand beleaguered employees.
But even that small gesture is now in question, as the Health and Human Services Commission omitted the largest single group of health attendants, who serve about 130,000 low-income Texans.
The discrepancy was uncovered this month by Dennis Borel, an advocate who heads the Austin-based Coalition of Texans with Disabilities.
“If you’re helping people out there making $8.20 an hour, $8.50 an hour, and they get a $400 or $500 bonus, that’s meaningful,” Borel said. “The fact that they did not include this largest of the community attendant service programs is a huge concern.”
The agency has not publicly acknowledged the exclusion, but says it may expand eligibility in the future. Payments will be distributed as hourly wage increases for services provided from March through August of this year.
“We are considering including additional populations of personal attendant services and we’re working with our federal partners to determine next steps,” spokeswoman Christine Mann said in an email.
The program at issue is called STAR Plus and provides daily home care and other long-term services to adults who have a disability and are considered low-income. About 300,000 people relied on Medicaid attendant services statewide as of 2019, with STAR Plus the largest single group.
Attendant positions are some of the lowest paid jobs in health care, earning a Medicaid-funded base rate of $8.11 per hour — less than a dollar more than the state’s minimum wage. Home care providers often pay more than that, but many still find it difficult to compete with restaurants and other hourly-wage industries that can afford more.
The Texas Association for Home Care and Hospice, which represents providers, said it had reached out to the state health agency to understand why any group had been left out. Its director, Rachel Hammon, expressed separate concerns at a hearing last week that the bonuses were not going to private duty nurses — a different group from the STAR Plus attendants.
State Sen. Charles Perry’s staff said they had also inquired.
“HHSC stated that they are aware of this and it is not their intention to exclude these attendants, and they are actively working to include them,” Chief of Staff Robert Papierz said in an email. Perry is a Lubbock Republican and is vice chair of the Senate Health and Human Services Committee.
If the omission turns out to be a clerical mistake, it could be tricky to fix, since the state has already negotiated with federal health officials on a set amount for the bonuses — in this case $471 million.
That money became available through last year’s pandemic relief package known as the American Rescue Plan Act.
Borel and other advocates had hoped the state health agency would use the money to permanently increase wages, but the agency declined, saying it couldn’t sustain the bump.
“If no one at HHSC noted the exclusion of Medicaid’s largest community attendant program, that is also inexcusable,” Borel said.
The state Legislature has minimally increased base pay for personal attendants over the years, from $7.50 in 2014 to $8.11 as of 2021.
Home care providers have struggled for months to make up for worker shortages, in some instances cutting back services or delaying new programs, according to a report this year from the United Cerebral Palsy and the American Network of Community Options and Resources Foundation.
In Texas, the turnover rate for attendants was 46 percent in 2020, compared to 43.6 nationally. Vacancy rates for these positions were 12 percent in the state in 2020, up from 11 percent in 2019.
jeremy.blackman@chron.com
