RALEIGH, N.C. – The hourly amount Medicaid is willing to reimburse for caregiver support of older North Carolinians, or others in need, has decreased by almost $2 since state cuts were enacted in 2014. As a result, North Carolina caregivers are now paid $4 an hour less than the national average.

According to Allan Freyer, director of the Workers' Rights Project at the North Carolina Justice Center, that has the potential to impact the state's growing population of those who need care.

"It also ultimately degrades the quality of care," he says. "If you have someone who is trying to pick up hours at three different jobs, they're just not going to be able to provide the stability of scheduling with the senior they're caring for that the senior really needs."

According to a report released by the North Carolina Justice Center, North Carolina's over-65 population is projected to more than double by 2050. The median wage for caregivers is less than $10 per hour, which is $5 less than the state's overall median wage.

Based on the report's analysis, low wages can increase worker turnover and interrupt the continuity of care for consumers. Aside from the impact on those receiving care, it can also impact the caregiver's reliance on public assistance programs to make ends meet.

"You're either paying for it on the front end with increased wages, or you're paying on the back end with increased public assistance," says Freyer. "People in America need to be able to have enough money to put food on the table and pay their rent. If their wages aren't doing that, then they're going to have to rely on public assistance."

Unlike North Carolina, states like Montana and Maine have an automatic update mechanism to Medicaid reimbursements to ensure rates remain competitive to keep caregivers employed and paid a living wage.


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October is Long-Term Care Planning Month, and a few tips can help people when talking with their loved ones about this topic. Conversations about long-term care can be difficult.

Bandana Shrestha, AARP Oregon state director, said approaching the topic with compassion and care is key and noted that the 470,000 family caregivers in Oregon provide most of the care for close friends and family members, and need to be part of planning conversations.

"Making sure that you're talking early is really important, and also making sure you are involving all parties who may responsible for supporting somebody is really important," Shrestha said.

The population of people over age 65 is increasing rapidly in the U.S. and most will need long-term care supports of some kind, underscoring the need to begin planning for how that care will look.

Open enrollment for Medicare began this week and lasts through December 7th. But Shrestha noted the insurance program doesn't cover long-term care.

"There are certain provisions within Medicare where you can get some supports for being able to have short stays in long-term care facilities," Shrestha continued. "But otherwise, Medicare is really about your health care. It's your health insurance."

Oregon performed well on AARP's recent Long-Term Services and Supports Scorecard, ranking number seven in the nation. Although the state could do better in areas such as affordability, Shrestha says the state ranks high in terms of support for family caregivers.

"The reasons for that are policies like our recent paid leave law, which really is designed to help ensure that people have supports and can take time off when they need to care for themselves or for their loved ones," Shrestha said.

Medicare's open enrollment period starts tomorrow and runs through Dec. 7.

AARP Nebraska is encouraging Medicare recipients to review their supplements and Part D prescription drug plans. The good news for 2025 is the implementation of a $2,000 out-of-pocket cap for those on a Medicare prescription drug plan, which takes effect Jan. 1. It's one of several prescription cost-savings measures in the Inflation Reduction Act.

Todd Stubbendieck, state director of AARP Nebraska, said the cap should benefit a lot of Nebraskans.

"AARP fought to include this provision in a 2022 prescription drug bill that Congress passed," Stubbendieck pointed out. "About 15,500 Nebraskans will directly benefit, which means those people are currently paying more than $2,000 a year for their prescription drug coverage."

The Biden-Harris Administration estimated the cumulative out-of-pocket savings for Medicare Part D enrollees in 2025 will be more than $7 billion.

Stubbendieck reminded Nebraska seniors there can be considerable cost and coverage differences between plans, so it is important to review them during open enrollment. Nebraska's State Health Insurance Assistance Program and Volunteers Assisting Seniors can help, as can the online Medicare Plan Finder.

Stubbendieck stressed Medicare prescription plans can change from one year to the next.

"It's always important that you don't just assume what worked for you last year will work for you this year," Stubbendieck advised. "This is that moment of open enrollment where people should take that time. There are resources to help you go out there and review that plan to make sure you are getting the most cost-effective coverage."

In 2021, Volunteers Assisting Seniors helped 6,500 Nebraskans save a total of $1.2 million in Medicare costs.

Stubbendieck pointed to other money-saving provisions AARP helped secure in the 2022 Inflation Reduction Act Medicare prescription drug law.

"For the first time in our nation's history, Medicare is allowed to negotiate prescription drug prices," Stubbendieck emphasized. "The other thing that this bill did is it capped insulin prices for those on Medicare at $35 a month and a whole range of vaccinations are now free for folks who are on Medicare."

Some Nebraska seniors on expensive cancer, osteoporosis, pneumonia and Alzheimer's medications will also see lower co-payment costs from now to the end of the year because of another provision in the Inflation Reduction Act, the Medicare Prescription Drug Inflation Rebate program. And when the lower prices negotiated for the first 10 commonly used medications go into effect on Jan. 1, 2026, seniors nationwide are expected to save a cumulative $1.5 billion.

AARP Iowa has released a series of videos asking congressional candidates how they would support Iowans who are unpaid caregivers.

The group traveled Iowa this summer on its "Cruisin' for Caregivers tour" to not only educate people about the issue but to hear from caregivers about what is important to them. Caregivers from each district sat down with Congressional candidates to discuss the challenges they face and potential solutions. AARP Iowa said unpaid family caregivers in the state provide what amounts to about $5 billion worth of services every year.

Paige Yontz, state advocacy manager for AARP Iowa, said unpaid family caregiving is a top issue for Iowa voters age 50 and older.

"The fact of the matter is, these voters are the driving force behind every election," Yontz pointed out. "In Iowa, voters accounted for 54% of the total electorate in 2020 and 62% in 2022, that's voters in the 50-plus category."

AARP polling shows voters in this age group are more likely to choose candidates who have a plan to support unpaid family caregivers. In the videos, Iowa's congressional candidates have 30 seconds to describe their approach.

Seniors have said aging at home has become increasingly important to them and Yontz argued having the help and care they need to do that is critical.

"In Iowa, there are over 330,000 unpaid family caregivers that assist their loved ones with needs that allow them to remain independent in their homes," Yontz explained. "That might be medical care and finances to chores, transportation, grocery shopping, you name it."

AARP said nationwide, unpaid family members provide at least $600 billion in care and services to loved ones and others who need support.