Relating to support of direct care services and the direct care workforce, establishing a state minimum hourly wage for direct care workers under the Medicaid program, and including applicability provisions

This bill includes measures to support direct care services and the direct care workforce. DIVISION I. Division I of the bill requires Medicaid providers to comply with direct care worker minimum wage requirements.00 beginning July 1, 2030. The bill provides that the setting of a minimum hourly wage under the bill does not authorize a Medicaid provider who is paying a direct care worker an hourly wage above the required minimum to decrease the direct care worker’s current hourly wage. On or after July 1, 2031, this state hourly wage shall be increased by a cost-of-living adjustment amount as determined by applying the percent change in the consumer price index for urban wage earners and clerical workers, United States city average, as published annually in October in the federal register by the federal department of labor, bureau of labor statistics. This division of the bill takes effect upon the effective date of an increased appropriation to the department of health and human services (HHS) for the Medicaid program to provide a reimbursement rate increase to Medicaid providers who are subject to payment of the required minimum wage for direct care workers in an amount that offsets the increase in the required minimum wage paid by such Medicaid providers. DIVISION II. Division II of the bill includes provisions relating to support of the direct care workforce. The bill requires HHS to review the funding appropriated for the fiscal period beginning July 1, 2023, and ending June 30, 2025, for rebasing of case-mix nursing facilities to identify how the additional funding was utilized, and the extent to which direct care worker wages were increased as a result of the additional funding. HHS must report initial and final findings and recommendations to the governor and the general assembly. HHS is also required to review the outcomes of initiatives funded through the federal American Rescue Plan Act to support the health care workforce including the use of the funds to increase the pay and benefits of direct support professionals, and train, recruit, retain, and expand the direct support professional workforce, to determine if the initiatives should be continued, and report findings and recommendations to the governor and the general assembly by December 15, 2024. The bill also requires Iowa workforce development to replicate the survey entitled “Direct Care Workers of Iowa 2019 Wage & Benefit Survey”, released in June 2019, to survey wages and benefits for direct care workers in 2024, and publish a final report of the results of the survey by January 15, 2025. The bill requires HHS to use the results of the published survey to determine the appropriate increase in the Medicaid reimbursement rate for Medicaid providers to offset payment of the required minimum wage for direct care workers as specified in the bill, and report the reimbursement rate recommendations to the general assembly by March 15, 2025. Following implementation of the minimum wage requirement as specified in the bill, HHS shall use the report to develop an ongoing tracking system to determine if the required minimum wage is effective in increasing the wages Medicaid providers pay direct care workers, including the extent of the impact of the required minimum wage on such wages considering the years of experience of the direct care worker.