We are focused on expanding affordable coverage to those who lack coverageretaining and improving coverage for home care workers who have it and expanding affordable coverage to those who lack coverage.
Background
New York State’s commitment to its home care workers dates back to the late 90s when the state created the Home Care Health Insurance Demonstration, an initiative to fund health insurance for home care workers in the New York City metropolitan area. That initiative allowed 60 agencies to purchase insurance for almost 78,000 home care workers and their families beginning in 2000. The demonstration continued until April 1, 2008, when a newly legislated program, the Family Health Plus Buy-in (FHP Buy-in), replaced the Home Care Health Insurance Demonstration.
In January of 2006, the New York State Office of Mental Retardation and Developmental Disabilities created the Health Care Enhancement initiative to encourage its employers to offer health care coverage to direct care workers in its home and community based settings. This initiative continued through January 1, 2008, and has supported coverage for those previously without coverage, expanded benefits, and reduced premium and out-of-pocket health expenses.
Despite the creation of these coverage initiatives little is known about the actual health insurance status of the 190,000 home care workers, home health and personal care aides, who each day serve our seniors and disabled throughout the state. By PHI estimates, at least 45,000 home care workers in our state have either no coverage, or coverage that is grossly inadequate. PHI believes that if health insurance can be extended to the home care workforce, not only will a large number of low-wage workers receive coverage, but home care consumers will receive services from a healthier, more stable workforce.
Current Project: Expanding Affordable Coverage to New York’s Direct Care Workers
In order to better understand the coverage status of the home care workforce and evaluate the existing initiatives for their potential to expand coverage to all home care workers, PHI applied for and received a grant from the New York State Health Foundation (NYSHF) to document the current coverage of direct-care workers in home care across the state and to provide policy recommendations for expanding coverage to this workforce. The NYSHF recognized that the home care industry has some unique challenges that are intrinsic to the nature of the work (e.g., part-time, sporadic), geography (e.g., rural, urban), size of employer, and union affiliation. PHI will bring its expertise from its national campaign – Health Care for Health Care Workers (www.coverageiscritical.org) to bear on this New York project.
The project, Expanding Affordable Coverage to New York’s Direct Care Workers, is divided into two parts:
- Phase I – We will examine the implementation of the Family Health Plus Buy-in and the OMR DD Health Care Enhancement (HCE) initiatives, and at the same time, gather information from employers on current rates of health insurance coverage for their home care workers. We will pay specific attention to eligibility, affordability, adequacy of coverage and employer contributions. We have contracted with the Center for Health Workforce Studies at the School of Public Health, State University at Albany, to assist in this data collection effort. We will be working with Manatt Health Solutions to examine the FHP Buy-in and the HCE initiatives.
- Phase II – Using our survey data and the information collected on the transition from the Home Care Health Insurance Demonstration to the FHP Buy-in and HCE, we will outline specific challenges and the mechanisms that can be utilized to expand coverage to the home care workforce throughout New York State. In this phase of our work we will explore the following with respect to specific initiatives:
- Eligibility and enrollment;
- Risk adjustment and scope of benefits;
- Pooling mechanisms for employers;
- Affordability; and,
- Continuity and adequacy of coverage.
The final product will be a presentation to policy-makers, employers, consumer organizations and provider associations that will enable New York State can use to ensure and expand health insurance coverage for the home care workforce as one of the essential elements for ensuring a quality workforce.
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