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Sen. Quick and home‑care providers urge standard pay rates for Aged and Disabled waiver services
Summary
Supporters of LB486 told the Health and Human Services Committee that Nebraska’s current individually negotiated personal‑care reimbursement process produces wide pay disparities, makes workforce planning difficult and weakens rural access; testifiers also questioned DHHS’s fiscal note estimating tens of millions in new costs.
Sen. Dan Quick (District 35) opened the hearing on LB486 by saying the bill would end case‑by‑case rate negotiations and require the Department of Health and Human Services to adopt a standardized reimbursement schedule for personal‑care services under the Aged and Disabled (A&D) Medicaid waiver.
The bill’s supporters — including executives from AmaniCare and Caretech and representatives of LeadingAge Nebraska, The Arc of Nebraska and the Nebraska Home Care Association — told the committee that the department’s current approach lets resource directors negotiate different hourly rates with individual providers, producing “vastly different” pay for the same service in the same community. Tim Martens, chief operating officer at AmaniCare, said providers in identical markets are being reimbursed between roughly $26 and $48 per hour; he testified that new or out‑of‑state agencies have recently received rates $5–$6 an hour higher than long‑tenured Nebraska providers serving the same clients. Karen Zuger of Caretech said Nebraska is one of the few states without a standardized fee schedule and argued that a uniform schedule would allow agencies to compete on quality rather than rate bargaining.
Proponents tied the reimbursement issue to workforce problems. Martens and Zuger told senators that turnover among caregivers is high and that agencies cannot reliably plan raises or retain staff without consistent rates. They urged the committee to require the department to adopt a fee schedule based on a rate study (the bill references a 2022 CBIZ Optimus study) and to include a rebasing mechanism so rates are adjusted periodically for inflation and business‑cost changes.
Several testifiers warned the committee that the department’s fiscal note — which estimates roughly $86 million the first year and $88 million the next — is overstated because it assumes LB486 would apply to all A&D waiver services and to certain chore services that the bill does not cover. Providers said they had been told previously the impact would be in the single‑digit millions and asked DHHS to reexamine the assumptions behind its estimate.
Committee members pressed proponents about program scope, audit and quality controls. Witnesses described existing provider audits (annual reviews of caregiving files) and said the A&D waiver serves beneficiaries who would otherwise require nursing‑facility level care; they emphasized that keeping people in home‑and‑community‑based settings saves the state money overall. Multiple proponents pointed to a 2022 department rate study as the basis for a standard schedule; LeadingAge Nebraska cited a specific figure from that study (approximately $43.63 per hour) as a reasonable benchmark, while noting the study is now a few years old.
No formal action was recorded at the hearing. At the close of LB486 testimony the committee reported 3 proponents and no opponents on the record and moved on to the next item on the agenda.
Ending: Supporters urged the committee to advance LB486 to create a predictable, statewide fee schedule for A&D personal‑care services while asking DHHS to rework its fiscal calculations; senators indicated follow‑up questions about the fiscal note and rate study would be needed.
