Help at Home – one of the largest home- and community-based services (HCBS) providers in the country – is leaving the state of Alabama.
The company will lay off nearly 800 employees in the state as of Nov. 4.
Kristen Trenaman, the VP of public relations and marketing at Help at Home, told Home Health Care News that the state’s reimbursement and regulatory environment has made it tough to recruit, hire and retain caregivers.
“Help at Home has made the decision to exit Alabama in-home personal care operations across the state, which was not made lightly,” Trenaman said in an email. “We take our responsibility to provide the safest, in-home personal care services to our clients very seriously. Taking that responsibility into account, we believe we had no choice but to make that very difficult decision not to renew our annual contract effective Sept. 30, 2023.”
Based in Chicago, Help at Home Help at Home has more than 180 branch locations across 12 states. It provides personal care services to more than 66,000 clients via more than 53,000 caregivers.
The company has five main offices in Alabama – in Gardendale, Montgomery, Northport, Evergreen and Mobile. Its 785 in-state workers help provide care across 57 counties. It will offer severance packages to all full-time employees, as well as “retention packages.”
“The current reimbursement and regulatory environment for Medicaid-funded in-home care has made it difficult to recruit, hire and retain workforce and we have not been able to overcome these challenges in the state of Alabama,” Trenaman said. “We are working with the state and AAAs to transition 1,100 clients and their caregivers to other providers and/or the state’s Personal Choices program wherever possible.”
Medicaid reimbursement for HCBS has generrally gotten much better across the majority of states since the onset of COVID-19.
Federal funding has enabled states to bolster HCBS programs, but it is Help at Home’s belief that Alabama has not done enough. Other providers have previously told HHCN that the reimbursement landscape in Alabama is difficult to manage.
In certain states – such as Massachusetts, for example – Medicaid HCBS rates have begun to rival billing rates for private-pay home care services.
On the other end, Alabama is one of 10 states that hasn’t accepted federal funding to expand its Medicaid coverage under the Affordable Care Act, according to AL.com, which first reported Help at Home’s Alabama exit last week.
With razor-thin margins, it’s tough for HCBS providers to succeed in some states. Recruiting and retaining talent is already tough throughout the country for home-based care providers, but without the ability to raise wages, workers are generally lost to other options – whether in health care or elsewhere.
Help at Home is exiting Alabama at a time when it is growing elsewhere. It has been one of the most aggressive acquirers in home-based care over the last couple of years.
In August, it announced acquisitions in Indiana and Ohio. In March, it acquired an Atlanta-based provider. In January, it expanded its footprint in Pennsylvania with a rather large acquisition.
Last year, it became one of the largest HCBS providers in New York after two simultaneous acquisitions.
“We have no plans to exit other states as this is an isolated situation specific to the state’s approach to Medicaid-funded home care supports and services,” Trenamen said. “Help at Home continues to be committed to meeting the growing demand for in-home care for Medicaid populations in our core states, expanding into new states, enabling more seniors and disabled populations to age-in-place in their own homes while we continue our growth strategy moving forward.”
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