Over the course of the last decade, the United States has seen a significant increase in the use of Managed Long Term Services and Supports (MLTSS) within the Medicaid program. In order to ensure that MLTSS systems deliver high-quality services to people with disabilities and do not involve inadequate or overly medicalized service provision, states adopt certain requirements within their procurement for and contracting with MCOs.
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In Medicaid or Medicaid/Medicare managed long-term services and supports (LTSS) programs, states pay managed care organizations (MCOs) a per-member-per-month fee, or "capitation payment," which they structure to achieve policy goals. States often provide financial incentives that encourage MCOs to provide members with sufficient home and community-based services (HCBS) so that institutional placement can be avoided, and to work to transition institutionalized members back into the community. These incentives can help states “rebalance” their LTSS systems, meaning that they increase the pr
For years, training standards for personal care aides in Washington posed several challenges that affected consumers and workers alike. In 2012, advocates responded by successfully passing a ballot initiative that created a new training system for these aides—expanding learning objectives, increasing training hours, and introducing certification requirements. In just a few years, Washington raised the bar nationwide for training and certification. This report is part of a three-part series focusing on states that have led the way in developing personal care aide training standards.
In Iowa, training requirements for personal care aides are minimal compared to training requirements for home health aides and nursing assistants. Since 2006, Iowa’s long-term care leaders have been striving to create a competency-based training and certification system that spans all direct care workers and ensures high-quality care across populations and settings. While state lawmakers haven’t enacted training requirements for personal care aides, Iowa’s long-term care leaders have achieved promising results.
Arizona is among just 19 states that have enacted uniform training requirements for personal care aides (PCAs) across all Medicaid long-term care programs. The process by which the state adopted these training standards spanned from 2004 to 2012. During that time, home care leaders deliberated extensively over how to achieve a system that ensured a baseline level of competency among PCAs, while balancing the priorities of workers, consumers, providers, and the state. What was the need for PCA training standards in Arizona? How did home care leaders address that need?