Many Medicaid members have been experiencing the challenges with hiring qualified caregivers during the pandemic and especially now during the labor shortage. However, even before the pandemic it was extremely difficult to get qualified care. This is especially true in areas that are rural or farther away from population centers.

Many of us are allocated limited hours for which to hire somebody. With the pay scale being under $15 an hour, and with only being able to offer so many hours per week, many caregivers find themselves in a situation where they must work two jobs to make ends meet. A lot of people are finding that that's not sustainable and are opting out of this career field.

My child is higher functioning on the Spectrum but It is difficult for us to enroll him in a mainstream daycare program where a sensory overload can cause meltdowns. Many day care programs also don't permit him to have therapists to come in and work with him. However, because he doesn't need as much direct care, mainly supervision, It is a battle to keep our hours high enough to be able to hire somebody. We were once told that we would only have 5 hours a week.

My constructive suggestion is that Medicaid consider opening up more childcare facilities for children and families who would like the option of being able to take their children to a dedicated location.

You could offer caregivers far more hours and consistency with their schedule, they wouldn't have to worry about whether a family goes on vacation and not having hours to work for a week. The turnover for caregivers would probably be much less frequent, and save a massive amount of money on time and resources spent on boarding caregivers.

The child care centers can offer a range of sensory friendly, structured programs that meet the needs of children with many levels of abilities so that no child feels left out.

You can also have on staff drivers, with quality vehicles and buses to transport children to their medical appointments when they need to. And have space available to allow therapists to come in and work with the children.

This arrangement, would still be difficult to implement in rural or less densely populated areas, but in many cases it would help to solve the problem of labor because your ratio would be slightly different.

In in some situations you may not need direct one-on-one care all the time, but have a floater who can assist a child when a meltdown occurs or helping with physical needs.

The in-home caregiver program is amazing, and helps many families who need it in their household. We particularly appreciate that it has allowed for hours and hours of ABA to be conducted in our home.

But when you look at it in practice, it may not be entirely practical at a macro scale. You require a much bigger labor force to make it happen, and as we've seen this past year that labor force is rightfully demanding more equitable pay and better hours.

There has to be a better way to do this.