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Home Care Reimbursement Advocacy Toolkit

HCAF's policy team is gearing up for the 2022 Florida Legislative Session, which begins on January 11, 2022. The home care sector's top policy priority is to have legislators address the detrimental impact that the minimum wage increase is having on home- and community-based care providers at this very moment.

Specifically, the legislature must take steps to minimize the fallout of the forthcoming $15 an hour minimum wage, especially for Medicaid providers whose rates are contractually fixed by state contracts and federal regulations.

HCAF needs every Florida home care professional to take action to raise awareness of this critically urgent policy priority to lawmakers, the media, and the general public.

If this is your first time advocating for your industry, no worries! This toolkit provides talking points and additional supporting information, and ways you can quickly and easily take action to have your voice heard.

For additional information or assistance, direct inquiries to Kyle Simon, Director of Government Affairs and Communications, at ksimon@homecarefla.org or call (850) 222-8967.

Thank you for your leadership and advocacy!

Latest Updates

New Legislative Delegation Meetings Announced (10/28/21) — Meetings have been added for Calhoun, Franklin, Liberty, and Taylor County legislative delegations in November. Details and instructions about how to attend and address the delegation are provided below in the schedule of upcoming meetings.

HCAF Hosts Home Care Provider Town Hall to Announce Advocacy Campaign (9/30/21) — HCAF hosted a town hall for home care providers to learn about the advocacy campaign. The recording and slide deck are available for download.

Without a corresponding increase in Medicaid reimbursement for home care services to cover the $15 minimum wage, it becomes financially unsustainable for any home care agency to provide certain services to Medicaid recipients. Moreover, not addressing this issue sooner than later will only compound the home care sector’s long-standing challenge of attracting and retaining workers to provide these services.

Click here to download the fact sheet that outlines the issue and solution for distribution to policymakers and the media.

  • Providers cannot hire staff at the current Medicaid rates.
  • Providers are often forced to turn away patients due to low reimbursement or are unable to deliver all the ordered visits that have been authorized.
  • The minimum wage increase compounds costly regulatory burdens for providers (e.g., Electronic Visit Verification mandate).
  • The $15 minimum wage is already here (e.g., Amazon, Bank of America, Starbucks, etc.). In fact, $15 is now considered too low a starting wage in some areas of the state.

Click here to view additional supporting information.

Email Your Lawmakers

Send a prepared email — or draft your own — to your State Senator and State Representative in just a few clicks

Schedule a Meeting With Your Lawmakers

Look up your State Senator and State Representative and call their local offices to schedule an in-person meeting

Address a County Delegation Meeting

Find out if your county's legislative delegation has an upcoming meeting to address every state lawmaker who represents the county

Contact Local Media

Write the editor of your community newspaper to raise awareness with the talking points above and supporting information

Schedule a Meeting With Your Lawmakers

Outside of advocacy days in Tallahassee and Washington, D.C., industry professionals are encouraged to meet with their lawmakers while they are home in their legislative district. HCAF staff is here to help coordinate the meeting, or you can follow the steps below to arrange your in-person meeting.

  1. Click here to look up your elected officials using the Legislative Action Center.
  2. Find the phone number for the district office nearest to you.
  3. Here is a sample script for you to use:

Hi, my name is [NAME] and I’m your constituent calling from [CITY].

I am calling to set up a meeting with Senator/Representative [LAST NAME] to talk about a home health care policy matter I care about. What is Senator/Representative [LAST NAME's] availability to meet in [HIS/HER] district office or another convenient location in the district?

[If the staff person asks for additional information, provide a short summary of this issue using the overview and talking points provided above.]

Thank you for setting up this meeting and I look forward to talking with Senator/Representative [LAST NAME] on [DATE/TIME] at [LOCATION].

Prepare for your meeting by utilizing the talking points provided above and additional supporting information below. Click here to download a fact sheet to share with lawmakers and staff in your meetings. Please keep us posted about your meeting or request assistance by emailing Kyle Simon, Director of Government Affairs and Communications, at ksimon@homecarefla.org or call (850) 222-8967.

County Legislative Delegation Meetings

County legislative delegations — which include every State Senator and Representative who represents a given county — hold public hearings each year to afford local officials, the public, and other interested parties the opportunity to present legislative proposals or express opinions on state issues.

Find out when your county’s Legislative Delegation is meeting so you can share your priorities with your legislators (we continue to update the list of meetings as new information is available). A listing of meetings and talking points to help you craft your message are below. If your agency is located in or serves a county that is holding a meeting — or if you are a resident of the county — please consider attending a meeting and speaking up.

Monday, December 6, 2021

Okaloosa County

  • Time: 10:00 AM-12:00 PM ET
  • Location: Dolly Hand Cultural Arts Center, 1977 SW College Dr, Belle Glade, FL 33430
  • Instructions: Click here for details.

Tuesday, December 7, 2021

Escambia County

  • Time: 5:30-7:30 PM CT
  • Location: Pensacola College Jean & Paul Amos Performance Studio, 1000 College Blvd, Pensacola, FL 32504
  • Instructions: To request an appearance form to be placed on the meeting agenda, individuals should contact Doug Broxson's office at (850) 595-1036 or email bell.victoria@flsenate.gov no later than 5:00 PM.

Wednesday, December 8, 2021

Palm Beach County

  • Time:10:00 AM-12:00 PM
  • Location: Dolly Hand Cultural Arts Center, 1977 SW College Dr, Belle Glade, FL 33430
  • Instructions: Click here for instructions to attend and address the delegation.

Write a Letter to the Editor

Letters to the editor are great advocacy tools to raise public awareness about an issue. After you write letters to your elected officials, sending letters to the editor can achieve other advocacy goals because they:

  • Reach a large audience.
  • Are often monitored by elected officials.
  • Can bring up information not addressed in a news article.
  • Create an impression of widespread support for or opposition to an issue.

Organize your thoughts on the issue and be sure to describe how it impacts others in your community to enhance its impact.

For tips on writing an effective letter, click here.

Supporting Information

On November 3, 2020, more than 60% of Florida voters effectively increased the state minimum wage from $8.56 to $15.00 in 2026. Amendment 2 will increase the minimum wage based on the following schedule.

  • $10 on September 30, 2021
  • $11 on September 30, 2022
  • $12 on September 30, 2023
  • $13 on September 30, 2024
  • $14 on September 30, 2025
  • $15 on September 30, 2026

Beginning on September 30, 2027, there would be an annual adjustment to the minimum wage based on increases to the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W).

The following messaging is a high-level overview of the challenges that home care providers are already facing, which will only compound as the minimum wage climbs to $15 an hour in 2026. Your personal story and on-the-ground experiences are the most impactful — use these talking points and your agency and workers' experiences throughout the COVID-19 public health emergency and the ongoing health care workforce shortage crisis.

  • Click here to view a report commissioned by HCAF that supports the need for an increase in Medicaid rates following the passage of Amendment 2.
  • The average hourly wage for Florida’s 76,040 home health and personal care aides is $11.84, according to the U.S. Department of Labor.
  • Home health aides and personal care aides help people with disabilities, chronic illnesses, or cognitive impairment by assisting in their daily living activities. These are not and should not be considered minimum wage jobs, but wages for these front-line workers are dictated by outdated and low reimbursement rates from payers, including Medicare, Medicaid, and private health insurance plans.
  • The associated cost of a $15 minimum wage per home care agency varies significantly across geography, size, and type of provider. For example, the minimum wage increase makes no distinction between different regions across the state. The cost of living in Miami, Tampa, or Orlando is far different than in Live Oak, Chipley, or Sebring. Providers in smaller, less expensive areas are disproportionately impacted by this sweeping increase in the minimum wage.
  • Home care agencies already operate on slim margins. While private pay home care agencies and other non-health care businesses can choose to offset their losses by raising prices for consumers, that’s not an option for health care providers whose services are largely reimbursed by Medicare and Medicaid.
  • Specifically looking at Florida Medicaid, the fee-for-service reimbursement rates have remained stagnant for over a decade while the costs of living and doing business have increased. Medicaid’s maximum reimbursement for a “home health aide visit unassociated with skilled nursing services” is $17.46 per visit, which leaves little or no profit for the home care agency to cover other necessary business expenses (e.g., licensure, accreditation, insurance, office space, marketing, technology, employee education and training, background screening fees, etc.).
  • In addition to already low Medicaid fee-for-service rates, Statewide Medicaid Managed Care (SMMC) health plans traditionally reimburse providers at even lower rates. Moreover, approximately 80% of Florida's more than four million Medicaid recipients are enrolled in a private health plan through the SMMC program. Although a $15 minimum wage increase could spur lawmakers into increasing State fee-for-service reimbursement rates, SMMC health plans are not required to follow suit, thus forcing providers to provide the same level of high-quality care with even less reimbursement for servicing the vast majority of the Medicaid population.
  • Without a proportional increase in reimbursement, the ripple effect will be quick and significant and could turn back the progress Florida has made in transitioning Medicaid recipients from institutional care to the community. For example, in 2013 the state reported that six out of 10 Medicaid long-term care program recipients resided in a nursing facility that year. By 2018, six out of 10 Medicaid long-term care program recipients resided in the community.
  • The home care industry has long experienced challenges with recruiting and retaining caregivers in order to develop and grow this essential workforce. The current reimbursement structure and a $15 minimum wage will further compound home care agencies' ability to offer competitive wages with a growing number of private companies (e.g., Amazon, Starbucks, Bank of America) already paying $15 or more per hour.
  • According to the Agency for Health Care Administration (AHCA), 205,216 Florida Medicaid recipients received in-home care services in 2020. All told, 23,065,191 service units were paid by the health plans contracted through the Statewide Medicaid Managed Care program.
  • The bottom line — Without a proportional increase in reimbursement rates, the resulting unintended consequences could mean:
    • Agencies forced to change their service offerings or close their doors for good
    • Caregivers lose their jobs
    • Patients experience barriers to accessing services and supports