Home-Health Employers Seek Exemption To ACA Regulations

July 28--HELENA -- Next year, all large employers will be required to offer health insurance to their workers -- and for health care firms that rely on government funding to provide services to the poor, that mandate poses a special problem.

"We don't have the ability to cost-shift," said Mike Hanshew, a consultant for Montana-based Consumer Direct, which employs 10,000 in-home health workers in 11 states, including 1,400 in Montana. "We can't raise our price because it's going to cost more."

Revenue for these companies is dictated primarily by Medicaid, whose payment rates are set by states.

Hanshew said if the companies are required to provide health coverage, they'll face "some pretty difficult choices," such as cutting employee hours or pay, to cover the cost of insurance.

Yet in Montana, Consumer Direct won't face that problem. Thanks to a program enacted by the state five years ago, Montana uses Medicaid money to help Consumer Direct and other Medicaid-financed providers of home health care buy private health insurance for their workers, who earn an average of $11 an hour.

"We give a lot of credit to Montana, which is giving health care (coverage) to their low-wage providers of health care," said Ben Bledsoe, president and CEO for Consumer Direct, which is headquartered in Missoula.

DeeDee Crider, a personal-care assistant from Laurel, had been paying $500 a month for health insurance before working for Consumer Direct -- and now pays $35 a month for medical and dental coverage.

"I just think it's been a blessing in my life, and it's a good opportunity for people who are wanting a job and looking for health insurance," she said. "It definitely attracted me to the job."

Crider works 25-30 hours a week providing in-home assistance to elderly and disabled clients, doing tasks like housekeeping, meal preparation, shopping or transportation.

"They only require 23 hours a week for you to be able to get the health insurance, so it's really good," she said. "Usually companies won't let you get your health insurance unless you're full-time."

Consumer Direct has been trying to get other states to adopt the Montana model, largely to no avail.

Now, Consumer Direct and other such providers are asking Congress to delay the Affordable Care Act's mandate that companies with more than 50 employees provide health coverage for those workers.

"If we can't get this changed at the federal level, then we're faced with some pretty difficult choices," said Hanshew. "Those are painful choices that will make it harder to recruit for a job that's already hard to recruit for."

The Montana Legislature enacted the program in 2007 with the hope of making home-health jobs more attractive, offering health coverage as a benefit with a difficult, low-paying job. The state also wanted to bolster in-home care, to keep people out of more expensive settings like nursing homes.

Companies like Consumer Direct hire and coordinate in-home health workers and are reimbursed by Medicaid, the state-federal program that pays medical bills for the poor and disabled.

Since 2009, the state has used Medicaid dollars to subsidize private health insurance purchased by in-home health care companies for their employees.

The state caps the amount of money that workers must pay for premiums (it's now $35 a month) and pays the company a set amount, based on the services it provides and the cost of the insurance.

If the health insurance costs more than expected, the company eats the difference. If it costs less, the company refunds part of the subsidy to the state.

In fiscal 2014, the state spent $4.7 million on the program, helping 17 companies buy health insurance for 528 employees. About two-thirds of the cost is covered by the federal government.

Bledsoe said once Montana enacted its program, the company began pitching the idea to other states, but two things got in the way: The recession and health care politics.

After the nationwide recession hit in late 2008 and 2009, most states faced big budget deficits and weren't about to take on new programs that increased Medicaid spending, Consumer Direct officials said.

Then, with the passage of the ACA in 2010, Consumer Direct began arguing that Montana's approach would be a good way to help the company provide health coverage and meet the ACA mandate, without saddling the company with too many additional costs.

Bledsoe said some states resisted because their legislatures or leaders opposed the ACA and "wanted it to fail."

"Everyone has an opinion on this huge national issue, but no one is willing to change anything, even when it comes to a group of low-wage workers who are providing health care," he said.

Now, as the 2015 deadline for the large-employer coverage mandate approaches, Consumer Direct and other Medicaid providers are appealing to Congress to give them an exemption.

U.S. Rep. Steve Daines, R-Mont., introduced a bill last week giving Medicaid-dependent producers a two-year reprieve from what he called the law's "oppressive employer mandate."

No action has been taken on Daines' bill, however, and Bledsoe conceded that it's getting to the "Hail Mary moment" to expect Congress to act before the mandate kicks in next year.

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