Will 20 cents be the difference for Oakland Co. direct care workers?

Originally posted in The Detroit News

by Hannah Mackay

For the Reinke family, which includes three adult children on the autism spectrum, direct care workers are essential to a functioning household.

The in-home professionals help people with intellectual and developmental disabilities navigate daily life, including providing personal care and supervising daily activities, and vocational training.

Lori Reinke and her husband have six direct care workers who support her children — Adam, Hailey and Bree — at their West Bloomfield Township home through two Oakland Community Health Network providers. The Oakland Community Health Network is the county's mental health authority that oversees all of the publicly funded services for mental health, substance use disorder, and people with intellectual and developmental disabilities, Chief Operating Officer Trisha Zizumbo said.

"As a parent, you really have to trust these people with your kid," Reinke said. "You're working with the most vulnerable population."

But finding people to fill those critical jobs is getting harder in Oakland County, where the health network has not raised the minimum pay for direct care workers since January 2023, despite getting funding increases from the state, Reinke and others said.

While the 2024-25 state budget allocated $28.7 million to fund a 20-cent-an-hour raise for direct care workers, setting the stage in Oakland County for the rate to rise to $16.30 an hour, at least two local advocates said they are uncertain if it will get passed along to providers in Oakland County this year and said it is insufficient to combat staffing issues.

The state Department of Health and Human Services gave all direct care workers in the state an 85-cent hourly raise last year, but OCHN's rates didn't change. Because of financial difficulties, the agency cut a previous $1 raise it had announced earlier in the year and then made up the 15-cent difference, so the pay rate of $16.10 an hour stayed the same. Providers are worried something similar will happen with the20-cent raise they are set to get this year.

The required minimum hourly wage for direct care workers in Michigan is $14.05.

Reinke is trying to find housing for her oldest daughter Hailey, 22, but said placing people in group homes is difficult due to a lack of staffing. She is currently on a waiting list.

"They can't place adults on the list, and it just gets hard because I've got three of them, and so even if I was to place Hailey, I still have two at home," Reinke said. "We want to see our kids be placed before something happens to us."

OCHN — the umbrella for a network of roughly 300 providers that receives federal, state, and local funding to provide services — is set to get its budget approved in September. If that happens, the 20-cent raise to $16.30 an hour would go into effect Oct. 1 and "absolutely" be passed along to providers, Zizumbo said.

"We're really grateful for the opportunity to be able to disperse that budgeted raise," she said.

The bulk of the 29,000 people OCHN serves are on Medicaid, the state-federal health insurance program for low-income individuals and families, Zizumbo said.

The Oakland Provider Alliance, a group of residential and vocational direct care professionals and parent advocates, said low rates make it difficult to attract and retain direct support professionals. They are losing workers to neighboring Wayne County, and the shortage is resulting in longer wait times to access key vocational, community living support, respite and residential care.

Worker shortage and waitlists

Shaindle Braunstein runs JARC, a Bloomfield Hills-based nonprofit that is part of Oakland County's provider network and helps people with developmental disabilities in group homes with independent living support and at-home care. She said waitlists are long for everything including vocational services, community living supports and at-home respite work.

"It is definitely because there are not enough workers to provide these services," Braunstein said. "That directly relates to not enough funding to pay workers a living wage so that they can afford to do this long-term."

Respite work, in particular, is key for Reinke because it provides relief for her as a primary caregiver. Respite workers allow her the rare time to do things for herselflike see friends or go out for dinner.

"There's been times where … it just gets to be too much, honestly," Reinke said.

“Thank God for respite workers because I can't leave our kids,” she added. “One of my daughters, I can't leave alone at all. She has to have someone 24/7 with her.”

Providers' leadership and management teams have to fill in for shifts regularly to maintain services, Braunstein said.

"That's scary when, again, we need not just every single resource that we have in the field, but we need directors to be providing care," Braunstein said.

Dawn Calnen, executive director at the Arc of Oakland County, a Troy-based advocacy organization for adults and children with intellectual and developmental disabilities, agreed that the county is facing a critical shortage of services.

"We are a county who has always prided ourselves in not having waiting lists,"Calnen said at a town hall event in Troy last month. "In every aspect of a person with a disability's life right now, there's a waiting list."

This only adds stress to families with members who have intellectual or developmental disabilities. 

“If the parent dies, then they're forced to look for placement, and then it's so much harder at that time,” Reinke said.

Flat rates since 2023

The state Legislature voted to increase funding and give all direct care workers an85-cent-an-hour raise last fall, but a budget shortfall from 2023 led OCHN to end a previous $1 per hour wage increase around the same time. The $1 raise had taken effect in January 2023 and expired nine months later.

OCHN made up the 15-cent difference and direct care professionals have maintained their current $16.10 rate since January 2023.

"We were really grateful that at that time, the state put in an 85-cent pay increase," said Christine Burk, chief of staff at OCHN. "That allowed us to keep that extra $1sustainable. Then we added 15 cents to make sure that the $1 was sustainable."

At the Troy town hall in June, several professional care providers and families of people with intellectual and developmental disabilities accused the county's health network of using state aid to reduce its spending. OCHN officials said they had to cut the $1-per-hour raise last fall to replenish a negative Medicaid savings balance left over from 2023.

The federal government declared a public health emergency at the beginning of the COVID-19 pandemic that required state Medicaid agencies to continue coverage for all medical assistance programs, regardless of changes to someone's eligibility.

OCHN's funding depends on the number of eligible Medicaid residents in the county, which increased during the public health emergency.

But when the COVID-19 public health emergency ended in 2023, the federal government forced states to reevaluate Medicaid recipients for eligibility. More than700,000 Michiganians have been disenrolled from the program for eligibility or procedural reasons, according to the state Department of Health and Human Services. OCHN was forced to reassess its financial position and end the $1-per-hour wage increase announced in January 2023.

"Just like going into the public health emergency was a first-time experience, navigating our way out of a public health emergency was also a first time," Burk said. "There are changes and things in the community we couldn't have anticipated."

OCHN acknowledged direct care workers' disappointment at the expiration of their rate increase, and Zizumbo said that all funds were pushed out to their provider network as they were available. Roughly 94% of OCHN's budget is dedicated to services, she added.

"We were able to give the money, even if it was for a short time. Luckily, it was sustained from the state, versus not giving anything at all," Zizumbo said. "I would rather be able to give them money, as much as we can, even if it's something that we're not able to sustain."

Legislature approves 1.2% raise

While providers and advocates agree that the hourly 20-cent raise approved in Michigan's budget that goes into effect Oct. 1 is better than nothing, it only amounts to a 1.2% hike for Oakland County direct support workers.

"I'm happy that there's any increase, full stop, right there. However, I mean, it's not enough," said Zach Cardinell, board president of AMORC, a volunteer advocacy group for Oakland and Macomb County families. "When you look at the history in Oakland County, wages have been frozen for almost two years. So a 20-cent increase for direct support professional wages is really not moving the needle at all."

JARC's Braunstein agreed that the 1.2% raise will not increase worker's standard of living or purchasing power in the face of inflation. She also fears that providers won't see the 20-cent increase, just as they had the $1-per-hour hike taken away.

Zizumbo said OCHN's direct support professionals would see the 20-cent hike.

"It's still an underfunded system. So do I personally believe $16 is a livable wage for somebody? You know, no," Zizumbo said. "What we really need to do is come together to advocate at the state level, at the federal level, to really increase funding for the system so that we're able to offer a higher wage and more money for direct services for people."

Improving access to behavioral health care is a key priority of the Michigan Department of Health and Human Services, which continues to work with other state agencies, partners and stakeholders to expand access to these services, department spokeswoman Lynn Sutfin said. The state supports the recruitment and retention of providers through scholarships and the expansion of loan repayment, she said, and continues to improve access to crisis stabilization units, mobile crisis response units and school-based health services.

Sutfin also pointed to recent increases in state funding for direct care wages, including an additional $1,768 annually for full-time workers in 2024, $728 in 2022and $4,160 in 2020.

"To help increase access, we have increased investments in behavioral health programs annually, including increasing direct care wages four times in the last six years. Recognizing the strain on Michigan’s health care workforce, the fiscal year2025 budget provides an additional $416 a year for full-time workers," Sutfin said. "While the actual rates are set at the county level, the funding in the MDHHS budget allows the state to fund the wage increases."

The consequences of not increasing funding for the system could be dire, AMORC's Cardinell said.

"I really see that we're in the midst of an extremely slow mass casualty incident," Cardinell said. "The people that need 24-hour care, what happens when there aren't people there to care for them anymore? And that's kind of the reality we're heading toward."