Case Studies of Six State Personal Assistance Service Programs Funded by the Medicaid Personal Care Option. VI. Attendant Issues: Family Providers, Wages, Benefits, Withholding


A. Family Provider Regulations

Currently the program excludes only spouses and legal or foster parents of minors, other family members can become paid providers. Parents of adult consumers providing PAS prior to program enrollment may be paid with Medicaid funds if the caseworker determines that the parent would otherwise be employed. One advocate notes sexism in this decision making process for some caseworkers: fathers may become paid providers but mothers are expected to provide PAS without reimbursement.

B. Attendant Wages

The state reimbursement per unit of service is $6.96 per hour as of May, 1991, but attendant wages usually are at or near minimum wage. Agencies may give the attendant wages slightly higher than minimum wage if there is a labor shortage or under special circumstances, e.g. if the attendant is needed for a split shift (i.e. working only in the mornings and evenings). Some agencies in rural areas may offer attendants a small reimbursement for mileage, but most do not.

C. Attendant Benefits

The agency covers mandated benefits (FICA, social security, and unemployment).

D. Withholding and Liability Issues

Private agency representatives say that the state does not adequately recognize the added costs of potential liability for worker's compensation claims. Getting an increase in reimbursement in order to cover expanded attendant benefits and worker's compensation is a key issue on the industry's lobbying agenda.

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