is pleased to share with you recent findings from the Centers for Medicare and Medicaid (CMS) Direct Service
Workforce Demonstration Grants focused on health care coverage in four states. Under subcontract with the
Lewin Group, PHI completed interviews and focus groups with the four state grantees (North Carolina, New
Mexico, Maine, and Washington) to determine the advantages, disadvantages, and policy implications of their
efforts. The attached report, Emerging Strategies for Providing Health Coverage to the Frontline Workforce in Long-Term Care,
details grantees’ experiences in offering or promoting health care coverage to direct-care workers and long-term
care employers. This report was prepared by PHI.
Purpose of the Grants:
In 2003 and 2004 CMS awarded grants to 10 states with the goal of developing innovative strategies to address
recruitment and retention of direct-care workers and help stabilize the workforce. CMS has put great emphasis on
making home and community based options viable for long-term care consumers. Six of the grantees, Indiana,
North Carolina, Virginia, Maine, New Mexico, Maine and Washington, developed projects to make health care
coverage more affordable and accessible to direct-care workers in their states.
Strategies in each state varied and included:
- Subsidizing employer-sponsored health insurance
- Establishing health reimbursement arrangements, similar to a health savings account, for direct-care workers
- Targeted outreach to small-long term care employers and large numbers of direct-care workers employed directly by long-term care consumers.
The key findings in this report illustrate that any effort to expand coverage to uninsured direct-care workers faces
substantial barriers that workers and their employers must take into account when securing affordable health
- Part-time work status and instability of hours, particularly in home and community-based services
- Low wages and high out-of-pocket costs
- Limited Medicaid reimbursement to providers of long-term care services
- High cost of care exacerbated by high-risk groups and small risk pools common among long-term careemployers.
In addition to understanding barriers to coverage, important policy implications rose out of this demonstration
project that speak to the need of broader research and policy changes to make health care coverage available and
accessible to this vital workforce. These areas include identifying ways to:
- Build the cost of health care coverage into Medicaid reimbursement methodologies
- Design state-subsidized health insurance programs, like the Michigan First Health Care Plan, that will meet
- the needs of the direct-care workforce
- Conduct effective outreach to non-traditional workforces and small businesses.
lessons learned to continue working with you in the future to make health insurance coverage available to direct-
care workers in Michigan.
If you have any questions or would like to discuss this report further, please contact me at (517) 372-8310 or