The Area Agencies on Aging (AAAs) in Arizona strive to keep older adults and younger adults with physical disabilities in their homes as they age. Home and community-based services (HCBS) are critical to achieving this goal. HCBS include adult day health, assistance with bathing and dressing, meal preparation, shopping, bed linen changing, caregiver respite, home nursing, and homedelivered meals.

HCBS are the primary buffer to the slow expansion of people needing more expensive support such as nursing home placement or other forms of institutionalization, including expanding their care through the Arizona Long-Term Care System. If older adults are not able to get the support they need at home they are more likely to come to the attention of Adult Protective Services (APS), often for reported self-neglect, or end up in an emergency room. No matter what emergent care they receive, it will be costlier than providing services to keep them safe and in their own homes with dignity. According to DES, approximately 17% of all HCBS cases were referred by APS for on-going service. This link between APS and the AAAs is a vital connection that helps older adults get the services and support they need.

With much-appreciated additional funding appropriated by the Executive, the AAAs have been able to reduce the waiting list for HCBS, which was nearly 2,500 people in January 2019. However, with both the provider rates and minimum wage increasing with no dedicated financial relief to the AAAs, continuing to sustain service levels is a challenge.

Over the past year, AHCCCS has increased fee-for-service rates for HCBS for “Elderly and Physically Disabled Providers” (EPD) by $11.8 million (7%). Because the AAAs are not funded through AHCCCS, but rather are funded through DES Division of Aging and Adult Services (DAAS) and did not receive an equivalent increase, there is now a disparity in the system that disadvantages the AAAs in contract negotiations with providers.

For the past 3 years, the AAAs have not received any increases for the rising minimum wage. In January 2020, the minimum wage will increase by 9%, making the already difficult disparity worse. With the combined increases in the minimum wage and the AHCCCS/EPD rate increase from last year, the AAAs need $2.5 million to achieve parity with current rates. EPD providers are requesting an additional increase this year, estimated to be 14.8%. To further maintain parity within the long-term care system, the AAAs will need an additional $2.5 million.

The Arizona Association of Area Agencies on Aging (AZ4A) is requesting an additional $5 million in General Fund appropriations to be allocated to DES/DAAS to match increases from prior years to AHCCCS/EPD, the increases in the minimum wage, and the proposed 14.8% increase in AHCCCS/EPD.