COFAR blog

Shannon Guenette still hasn’t seen any of the money even though Congress and the Biden administration released $8.7 billion in federal stimulus funds to Massachusetts last March.

“We’ve received some guidance (from the state regarding the funding), but we haven’t received any additional funds,” Guenette, executive director of Almadan, Inc., said five days prior to Thanksgiving. Almadan is a group home provider in the western part of the state to the Department of Developmental Services (DDS).

In August, Guenette told us her agency and other DDS providers throughout the state desperately needed the additional federal funding to retain workers in light of a worsening shortage of direct-care and clinical staff.

The Baker administration in Massachusetts has targeted hundreds of millions of dollars of the federal American Rescue Plan Act (ARPA) funding for human services workforce retention and recruitment.

But the state Legislature took months to come up with its own plans for distributing the funding after at least one legislative leader said they didn’t see a need for hurry.

Earlier this month, state legislators went home for their Thanksgiving recess without having reconciled Senate and House bills (S.2564 and H.4234) that specify differing distribution plans for the money.

Meanwhile, other than noting there will be three rounds of ARPA funding distribution, the administration itself has provided little clear information about the details of its distribution plan such as how many workers and which agencies would receive the money, and how much of that funding would go toward higher wages.

Under the administration’s plan, the first round of funding was supposed to augment provider rates by 10% from last July through December of this year. But, as noted, no money has reportedly been distributed for residential programs.

Repeated queries by COFAR to DDS Commissioner Jane Ryder and to Health and Human Services Secretary Marylou Sudders about the DDS staffing shortage and how to address it have gone unanswered.

Even when the ARPA money is finally distributed, we are concerned about a potentially low limit set on the amount of funding per worker under the Senate and House bills. Also of concern is a lack of clear oversight of the distribution of the funding.

And it appears at least some of the funding is intended to be used to move residents out of the state’s two remaining developmental centers and into the already overburdened privatized group home system.

A $2,000 limit per worker

Language in both the Senate and House bills would limit funding for higher wages to $2,000 per worker. It’s not clear how effective such a payment would be in recruiting and retaining workers, particularly if it is only a one-time payment.

The Senate bill would also establish an advisory panel to make recommendations to the administration regarding the “Essential Employee Premium Pay Program.” The panel’s report is due with its recommendations by March 31, 2022.

The advisory panel sounds like a potential recipe for further delay without necessarily providing a structure for ensuring that the funding goes to the workers.

The distribution of funding to workers may not have sufficient oversight

Information posted online by the administration requires DDS providers to attest or essentially promise that 90% of the additional ARPA funding they receive will be used for “compensation for their direct-care workforce.” That could include, “among other things,” hiring and retention bonuses.

While the providers will be required to submit spending reports, it isn’t clear that the administration has dedicated sufficient resources to auditing such reports and ensuring that the money is going in all cases to front-line staff.

State Auditor Suzanne Bump’s office reported in 2019 that increases in state funding to DDS and other providers resulted in surplus revenues for the providers, but that those additional revenues led to minimal increases in wages for direct-care workers.

According to Bump’s audit, while the increased state funding was at least partly intended to boost direct-care wages, it “likely did not have any material effect on improving the financial well-being of these direct-care workers.”

Some ARPA funding may be used to “divert” residents from developmental centers

According to the administration’s distribution plan, at least $44 million of the ARPA funding will be used starting in Round 2 to “divert” clients “towards community living … and away from facility-based settings.”

We are concerned that while at least some of this funding would reportedly be used to prevent the inappropriate placement of DDS clients in hospitals or nursing homes, a portion of the funding may be used to further reduce the population of facilities such as the Wrentham and Hogan developmental centers.  As such, this funding would only further reduce choices in residential care for DDS clients.

The residential population at both Wrentham and Hogan have been declining in recent years, and admissions to both facilities were zero in 2020.

Providers cite need for funding and higher pay for direct-care workers

In September, a provider-based “Collaborative” provided written testimony to the state Legislature’s Ways and Means Committee chairs seeking $174 million per year for five years in ARPA funding for human services organizations. The money was being sought “to provide recruitment and retention incentives to workers to help combat the workforce crisis in the sector.”

The Provider Collaborative testimony said the $174 million would affect about 34,800 staff earning less than $60,000, and nurses and clinicians earning less than $90,000.

The Collaborative noted that low wages paid to direct-care workers are a problem. “The low rates of pay for direct-care staff… coupled with complex, difficult jobs have led providers to struggle with recruiting and retaining workers even before the COVID-19 pandemic impacted programs,” the testimony stated.

The Collaborative blamed those low wages on the state’s “rate-setting process.” We think, however, that many providers, as the state auditor noted, could afford to pay more to their workers.

Shannon Guenette told us that Almadan is currently only able to pay its staff $15.25 an hour. The Collaborative stated that the median salary for direct-care workers is $16.79 an hour. According to the Collaborative, the MIT Living Wage calculator notes a living wage for a single person in the area is $17.74 an hour.

All of this points to the need for quick action to distribute the ARPA funding. It’s unfortunate that legislative leaders don’t appear to recognize that there is, and has been, a need for hurry. There is also a need for effective oversight of the funding to make sure it gets to those workers.