The time is now to establish a PCA rate framework

by the PCA Reform Coalition

The Personal Care Assistance (PCA) program, accessed by 44,000 individuals across Minnesota, is one of the most cost-effective Medicaid programs in our state, helping older adults and people with disabilities live and work as independently as possible in their communities. The PCA program is also the most diverse, as 62 percent of service recipients are Black, indigenous and people of color (BIPOC). A majority of the workers are women and BIPOC.

The services provided by PCAs, who help with a wide range of personal supports, has been a critical lifeline for thousands of our neighbors, family members, and friends since the 1970s.

Today, Minnesota’s PCA program – and the individuals who depend on it – are in crisis.

Over the last 12 years, the program’s reimbursement rate has only been increased by $1.56 per hour — an average increase of $0.13 per year. The current reimbursement rate is just $4.45 per 15-minute unit or $17.80 per hour.

PCA Choice employees are required to be paid $13.25 per hour, per the collective bargaining agreement with SEIU.

According to a 2020 legislative report the average PCA makes just $12.38 per hour. The average wage includes both Choice and Traditional workers – resulting in high turnover and causing reduced quality of care which is creating instability in the lives of people with disabilities and older adults.

Some Minnesotans have been left alone without care due to the PCA staffing shortages across Minnesota.

Other individuals who rely on PCA services have moved into more costly, restrictive settings like nursing homes or residential care facilities.

To ensure the sustainability and improve the quality of Minnesota’s PCA program, we must:

  • Establish a data-driven rate reimbursement framework.
  • Increase wages for PCAs and the Qualified Professionals (QP) who supervise the PCAs.
  • Decrease the requirement for the enhanced rate from 12 to 10 hours for individuals with the highest support needs.
  • Consistently collect statewide service provider data

Ensuring PCA Program Integrity

In addition to the needed PCA Rate Framework, the Minnesota Legislature has an opportunity to develop high-quality standards for all provider agencies that will add value to program participants, attracted to retain

PCAs, and ensure the sustainability of this crucial service.

To ensure sustainability and improve the quality of Minnesota’s PCA program we must:

  • Raise the bar for enrolled PCA agencies:
    • Require providers to update Department of Human Services (DHS) documents annually (bonds, insurances etc.)
    • Provide proof of two payrolls or a line of credit at enrollment and revalidation
    • Establish policies and procedures for provider operations and programs
  • Enhance PCA provider reporting requirements:
    • Provide financial statements demonstrating at least 72.5 percent of the unit rate is paid to PCAs
  • Consistently collect statewide service PCA provider data

By formalizing best practices statewide, members of the Minnesota Legislature and the general public will be able to trust in the stewardship of Medical Assistance dollars which fund the PCA program.

Increased provider standards will reduce and prevent fraud, waste, and abuse in the PCA program, while improving the quality of services accessed by individuals with disabilities and older adults.

The editorial was prepared by the PCA Reform Coalition, which includes several disability service providers.