RI BHDDH Seeks $20 Starting Wage For DD Workers

By Gina Macris

The state agency overseeing Rhode Island’s services for adults with developmental disabilities is asking for a $20 minimum hourly wage for direct care workers, effective July 1.

The hike was ordered by a federal judge in 2021 to go into effect by 2024, causing consternation in the General Assembly at the time. More recently, outside consultants concurred with the minimum $20 rate.

The request is part of an overall $430.1 million budget proposal for developmental disabilities that the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) has submitted to Governor Dan McKee.

McKee is to submit his spending and revenue plan for the state to the General Assembly on Jan. 19.

RI BHDDH

The BHDDH request for developmental disabilities would add $9.3 million to the current budget of $383.4 million to close a budget deficit in the current fiscal year, ending June 30. About $6 million of the shortfall comes from a state-operated network of group homes.

An additional $37.4 million would be needed to reach total funding of $430.1 million for developmental disabilities in the next fiscal year, beginning July 1.

Spending on developmental disabilities makes up nearly two thirds of the entire BHDDH budget, which is currently $597.1 million. For the next fiscal year, BHDDH is seeking nearly $621.4 million, an increase of of about $24.3 million.

Slightly less than half of BHDDH’s operating revenue comes from state tax dollars, with the rest funded by federal Medicaid money. The overall figures also include some other miscellaneous funding sources.

In a cover letter to the governor in November, BHDDH director Richard Charest said the “Division of Developmental Disabilities continues its commitment in complying with the terms of the 2014 federal consent decree and providing integrated employment and day services.”

A series of substantial wage increases is intended to help stem a worker shortage that prevents eligible adults from gaining access to services to which they are entitled, particularly during the the recovery from the COVID-19 lockdown.

Under pressure from the U.S. District Court, which oversees the consent decree, the General Assembly increased hourly wages from $13.18 to $15.75 in 2021, and then to the current $18.00, which became effective July 1, 2022.

Chief Judge John J. McConnell, Jr. ordered state to hit $20 an hour by 2024. And the outside rate reviewers included the $20 minimum wage in preliminary recommendations made public last September. They also recommend a minimum rate of $22.14 in the fiscal year that would begin July 1, 2024.

As much as the state has been criticized by providers, advocates, and consumers and their families during the last decade for underfunding developmental disabilities, adding more money will not solve all the compliance problems the state has with the consent decree.

 Since 2014, the Department of Justice and the federal court system have sought to oversee a cultural shift in the delivery of services which will enable adults with intellectual and developmental disabilities to live regular lives in their communities, exercising choice about where they work and spend leisure time.

In a hearing in U.S. District Court in December, a lawyer for the Department of Justice said the state appeared unlikely to meet a deadline in mid-2024 for full compliance with the consent decree. Amy Romero of the U.S. Attorney’s office in Rhode Island expressed concern about a lack of individualization or “person-centered-ness,” and inadequate accessibility to services in a number of categories, including supports for teenagers making the transition to adulthood.

Romero’s criticism, as well as that of an independent court monitor, stemmed only partly from a chronic shortage of underpaid direct care workers who make up the front line of consent decree compliance.

How the state spends the money, including the degree to which services are individualized, is entwined in the rate review by outside consultants that has been underway for nearly a year. The rate review - itself court-ordered – has not yet been finalized. It covers not only the reimbursement rates to private service providers but the state administrative structures governing the spending.

Preliminary recommendations from the consultants indicated the state wants to continue the existing fee-for-service system, now 11 years old, with many of the same administrative features, including billing for daytime services in 15-minute units and a relatively limited number of individual funding options.

One big change is a proposal to make job-related supports available to all adults with developmental disabilities as an add-on to basic individual budgets.

Officials are working to finish the rate review by the end of January, according to a newsletter of the Division of Developmental Disabilities (DDD) issued Jan. 13.

In the same newsletter, DDD announced that it will advertise eight new positions to help the state fully comply with the consent decree by mid-2024.

The expanded staff will “assist the Division in developing improved communication with the I/DD community and stakeholders, increasing our training capabilities, and enhancing our support for community access and the self-direction population.” (The self-directed population includes individuals and families who design their own programs – roughly a quarter of the caseload of about 4,000 individuals eligible for services.)

The newsletter offered no additional details about the new positions, nor were any immediately available from BHDDH.

The privately-run developmental disabilities system, which includes the self-directed group and private agencies running group homes and offering daytime services, is currently funded for $352.9 million, with about $173.4 million coming from federal Medicaid reimbursements. BHDDH wants $40.7 million more for the private system from both federal and state Medicaid funds, including about $2.9 million to cover a shortfall in the fiscal year ending June 30.

A parallel network of state-run group homes, currently funded for nearly $30.6 million, would need an increase of about $6 million to balance its budget for the current fiscal year, according to the BHDDH budget request. Funding for fiscal 2024, beginning July 1, would continue at the higher level, about $36.5 million.

The administration of former governor Gina Raimondo had tried to privatize the state group homes, but private operators made it clear they were in no financial position to take on the responsibility for additional residents. The plan also faced opposition from unionized state employees who staff the state system, called Rhode Island Community Living and Support (RICLAS). Governor McKee has made it clear he will continue to support RICLAS.

RI House Gives Extra Bump To Pay Of Front Line DD Workers As Budget Deliberations Near End

By Gina Macris

The Rhode Island House has added a total of $9.6 million in federal-state Medicaid funding to boost the pay of direct care workers for adults with developmental disabilities in the state budget for the fiscal year beginning July 1.

The increase, awaiting approval by the Senate, represents the largest single-year investment in wages since drastic cuts were made in 2011. In 2016, the legislature earmarked $5 million for a rate hike, and the next year it added $6.1 million.

But the rates for Rhode Island’s direct care workers still lag behind those of neighboring Connecticut and Massachusetts.

This year’s wage hike is was part of an overall $296.9 million allocation for developmental disabilities, which includes $13 million in federal Medicaid reimbursement to create a third-party case management initiative called a Health Home.

In an unusual Saturday session June 22, the House also addressed a shortfall in the current developmental disabilities budget, adding $2.9 million in supplemental funding.

Developmental disability services encompass both the private system serving about 4,000 clients and a state-operated network of group homes for about 125 individuals, accounting for more than half the spending in the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH). The House-authorized spending cap for BHDDH in the next budget is $463.2 million.

A spokesman for House Speaker Nicholas A. Mattiello explained a floor amendment that raised the total earmarked for a wage increase in Governor Gina Raimondo’s budget from $6.4 million to $9.6 million.

Larry Berman said the governor’s $6.4 million, including $3 million in state funding and $3.4 million in federal reimbursements, will mean a 41-cent raise to the hourly rate for direct support workers on July 1. The hourly rate, which he put at an average of $12.27, would rise to $12.68, Berman said.

The additional $3.2 million in the floor amendment, including $1.5 in state revenue, will be applied Oct. 1, triggering an additional wage hike of 41 cents an hour, for a total hourly rate of $13.09 during the last nine months of the fiscal year, Berman said.

In the past, increases for direct care workers have meant that supervisors and other support personnel have also received raises. But Berman confirmed that this year, the allocation earmarked for pay bumps apply only to front-line caregivers. In all, about 4,000 work in the private sector in the field of developmental disability services.

Berman’s figures refer to the basic hourly wage rate in the BHDDH reimbursement model for private providers, but that doesn’t mean each direct care worker will get the increase he cited.

Many variables exist in the way each of the providers figures out how much to pay workers and how much to set aside for benefits and other employer-related expenses. All that means that the amount of the actual wage hikes will vary.

In the past, the state and the private providers have differed on how far a rate hike will go.

In a statement, Mattiello took credit for redirecting additional funds to direct care workers.

“When about $1 million was identified as available in the budget, I suggested it go to those workers who are providing outstanding care to the developmentally disabled community. They deserve this rate increase.”

The Community Provider Network of Rhode Island, (CPNRI) a trade association of about two dozen providers, posted its thanks on Facebook:

“CPNRI is pleased to see the commitment of the Speaker, Senate President and Governor and all the Representatives and Senators who have supported increased wages for DD workers in Rhode Island in the 2020 budget. This investment not only will raise wages for this invaluable workforce, it supports individuals with intellectual and developmental disabilities to lead meaningful lives in our communities. Thank you to all who have prioritized this workforce.”

The wage increase is assured passage in the Senate, where developmental disability services have the support of the leadership, including Senate President Dominick J. Ruggerio, William J. Conley, Jr., Chairman of the Senate Finance Committee; and Sen. LouisA. DiPalma, first vice-chairman of the Senate Finance Committee.

The extra push in funding occurred just as Mattiello sought to tamp down a controversy involving a Cranston chiropractor, who was to receive a $1 million authorization to bill the state for services for an unproven neurological treatment for traumatic head injury and other disorders that failed to qualify for federal Medicaid reimbursement..

On June 20, Mattiello announced he would pull the $1 million in funding from Victor Pedro, because the issue had become too controversial and he wanted to avoid a lengthy floor battle, even though he still supported the chiropractor.

Berman said most of the last-minute $1.5 million-increase in worker wages came from the allocation that Mattiello pulled from the chiropractor, along with funds from various other accounts.

Spending for already-established developmental disability programs and services from all revenue sources in the next fiscal year would be capped at $284 million – about $12.3 million more than originally approved for the current fiscal year. Most of that figure comes from the federal-state Medicaid program.

Meanwhile, the House approved a revised developmental disabilities budget of slightly over $274.6 million for the current fiscal year, which is $2.9 million more than the $271.7 million the General Assembly enacted a year ago.

The revised figure includes about $1.7 million in state revenue that represents an adjustment for an audit finding that the state was incorrectly leveraging federal Medicaid money to pay for fire code upgrades in group homes and other facilities serving adults with developmental disabilities, Berman said. Capital projects are now all assigned to the Department of Administration, he said.

Without supplemental funding and savings in other BHDDH accounts, the cost of services in the privately-run developmental disability system would have exceeded the amount the General Assembly originally allocated by about $3.8 million in General revenue.

A third-quarter spending report prepared by BHDDH said that the total state share of Medicaid-funded direct services in the private system is projected at about $111.4 million by June 30. The enacted budget for the current fiscal year allows $107.6 million in that category, but the supplemental funding recommended by the Governor and approved by the House reduces the projected shortfall in state funds to about $152,000, when combined with savings in other accounts.

In the third-quarter spending report for the current fiscal year, BHDDH officials project about a 1.5 percent increase in overall caseload growth and a $1.5 million increase in supplemental funding to clients who successfully appeal the individual amounts allocated for their services.

Counting all the Governor’s proposed supplemental funding for BHDDH in all three divisions, as well as savings in some budget line items, the department projected a year-end surplus of about $438,000 as of March 31.

UNAP Settles With Seven Hills Rhode Island In Mediation That Results In 25-Cent Hourly Raise

By Gina Macris

Workers at Seven Hills Rhode Island who care for about 250 adults with developmental disabilities will receive an across-the-board raise of 25 cents an hour retroactive to last June 23, the expiration date of their previous labor agreement. The contract contains a wage re-opener in its second and final year.

The mediated settlement was ratified last month by some 200 members of the United Nurses and Allied Professionals (UNAP), according to Jeanne Jose, a union business representative. Any increase that comes from Governor Gina Raimondo’s proposed budget for the fiscal year beginning July 1 would be over and above the raises negotiated in mediation, Jose said.

In January, the union membership authorized its executive committee to call a strike, if necessary, after labor-management talks had collapsed the previous month.

According to Jose, the union had originally sought a 5 percent wage increase across the board. That percentage works out to about 55 cents an hour for those who had been making $10.94 an hour – more than half the membership. By comparison, the minimum wage in Rhode Island is currently $10.50 an hour.

Jose said 39 per-diem employees, who are on call but receive no benefits, were paid $12.36 an hour under the terms of the previous contract. Jose said 12 behavioral assistants, who must have bachelor’s degrees, made $15.36 an hour.

Talks fell apart in December when management offered a choice of an across-the-board increase of 13 cents an hour, or a 25-cent increase for those making $10.94 an hour and no raise for higher-paid union members.

Jose said “people were happy” with the wage settlement, taking into account Rhode Island’s chronic underfunding of developmental disability services, which has resulted in low wages and high turnover.

UNAP is one of several labor organizations affiliated with the AFL-CIO which support companion bills which have been introduced in the General Assembly to create a $15-hour minimum wage for direct care workers.

In a statement, Cliff R. Cabral, vice-president of Seven Hills Rhode Island, said, “We are pleased that we were able to come to a resolution and will continue to advocate on behalf of those who provide crucial supports to adults with developmental disabilities.”

In addition to the raises, Jose said, the union won a five-cent increase in mileage reimbursement for employees who must use their personal vehicles on the job – from 40 cents to 45 cents an hour – and other changes in contract language.

According to Jose, new language ensures that:

• Employees will receive adequate training or re-training before they are tested or re-tested on protocols for dispensing medication to clients.

• Management will provide adequate staffing to ensure the health and safety of workers and clients on an as-needed basis; for example, when two people are needed, instead of one, to help a heavy person using a wheelchair to get in and out of a car for a visit to the doctor’s.

Seven Hills, based in Woonsocket, is a private agency that provides residential and day services for adults with developmental disabilities in northern Rhode Island.

Mediator Steps Into Labor Dispute Over Low Wages At Northern Rhode Island DD Service Provider

By Gina Macris

Seven Hills Rhode Island and the union representing workers who assist some 250 adults with developmental disabilities have agreed to meet with a mediator in an attempt to settle a months-long labor dispute.

A union spokeswoman, Jeanne Jose, organizer for the United Nurses and Allied Professionals, said the first mediation session was Wednesday, Jan. 23, and the two sides agreed to meet again with a mediator next week. Earlier in the month, the union membership, about 200 to 220 employees, authorized the negotiating committee to call a strike, if needed, Jose said.

UNAP initially proposed a 5 percent increase in wages across the board, she said. More than half the membership makes $10.94 an hour, and a five percent increase would add about 55 cents to that rate. Thirty-nine per-diem employees, who are on call but receive no benefits, are paid $12.36 an hour. She said 12 behavioral assistants, who must have bachelor’s degrees, make $15.36 an hour.

In the most recent bargaining session in December, Jose said, management gave the union a choice: either an across-the-board increase of 13 cents an hour, or a 25-cent increase for those making $10.94 an hour and no raise for higher-paid union members.

Neither option is acceptable, she said. The union membership voted Jan. 9 to authorize the bargaining committee to call a walkout, if necessary..

Efforts to reach management, represented by Cliff R. Cabral, vice president of Seven Hills Rhode Island, have been unsuccessful.

Jose said the union also seeks to preserve health care benefits, which she described as “decent.” Employees pay 20 percent of costs, she said, but rising premiums have eroded take-home pay.

There are three other areas where the union wants improvements:

· An increase in reimbursement for transportation, from 40 cents to 45 cents a mile for direct care workers, who are required to use their own vehicles on the job. The standard reimbursement rate allowed by the Internal Revenue Service in 2018 was 54.5 cents a mile. For 2019, the IRS increased the rate to 58 cents an hour.

· Contract language that ensures employees will receive adequate training or re-training before they are tested or re-tested on protocols for dispensing medication to clients.

· Adequate staffing to ensure health and safety on an as-needed basis; for example, when someone who uses a wheelchair is too heavy for one worker to transfer from the chair to a car to go to a doctor’s appointment and return home.

UNAP has represented developmental disability workers at Seven Hills and its predecessor organizations since about 2005, Jose said. The last contract expired in June, 2018.

With direct support wages linked to government funding, the labor dispute underlines the gap between pay in Rhode Island and neighboring states for the same work.

In Connecticut, all direct care workers make $14.75 an hour, effective Jan. 1.

In Massacusetts, where they’re called Personal Care Attendants, those who belong to the Service Employees International Union make $15 an hour.

The minimum wage in Massachusetts is $12 an hour. In Rhode Island it is $10.50. Governor Gina Raimondo recently proposed raising the minimum wage to $11.10 an hour and a wage increase for direct care workers that would add about 44 cents an hour to their paychecks.

The trade association representing about two thirds of private providers of developmental disability services, including Seven Hills, has said the average entry-level wage among its member organizations is $11.36 an hour.

Seven Hills Rhode Island is affiliated with the Seven Hills Foundation, a multi-faceted human service agency which has a broad presence in Massachusetts.