Behavioral-health providers in Pennsylvania face financial instability because of inconsistent rate increases, affecting staff recruitment and retention.

In a survey from the Pennsylvania Council of Children, Youth and Family Services, one provider stated when increases occur, 70% goes to salaries, 20% to occupancy, and 10% to insurance.

Nancy Kukovich, CEO of the nonprofit youth services provider Adelphoi, recommended improved Behavioral Health Managed Care Organizations review processes for rate increase requests, citing insufficient state oversight over the rate request process.

She said their evidence-based multisystemic therapy is in need of a master's degree-level therapist, but due to lack of funding it's been difficult to recruit for this position.

"Its general claim to fame is behavioral health, but it is intense enough that it can keep kids out of the deeper end of the system," Kukovich explained. "They don't have to go to residential. They can get this really intensive service in their home. So, it's of great value to some of the counties, but it's not an inexpensive program."

The survey found Behavioral Health Managed Care Organizations sometimes offer increases during fund surpluses or when federal funds, such as the American Rescue Plan Act, are available. But the raises have not kept pace with providers' budget needs because of market competition and years of minimal increases.

Kukovich pointed out Adelphoi works with five Behavioral Health Managed-Care Organizations and has not received a rate increase in years. She noted they request the rate increase from the organizations and before approving an increase, they typically request information from providers to determine the value of the program.

"They go through a big process of trying to figure out, do we have enough of the service already? Do we need more of it? Is it something that's really important?," Kukovich outlined. "Then we usually have to fill out a whole lot of paperwork about what our costs are, what salaries look like, etc. We submit that information. We find out whether or not we get a rate increase."

Amy Fenn, senior director of Pennsylvania community-based services for Pittsburgh-based provider Pressley Ridge, oversees a variety of programs, including in-home mental health, child welfare, juvenile justice and others. She said the inconsistent rate increases ultimately affects their ability to attract and retain quality staff.

"The main thing is always salaries, because we give merit increases every year," Fenn emphasized. "Without rate increases, we're continuing to have higher costs but we still never feel like we can pay people as much as we as we should be, paying them as much as the work is worth, because without those regular rate increases, we just can't keep up with the expenses."

The survey shows behavioral health providers are competing with school-based jobs offering better pay and hours. To stay competitive, providers have raised salaries by up to 11%, despite limited funding. It recommends linking salary increases to actual costs and exploring flexibility within Behavioral Health Managed Care Organizations.


get more stories like this via email

The Indiana Chamber of Commerce outlined six key priorities for lawmakers ahead of the legislative session in January.

Rather than releasing detailed policy positions, the Chamber emphasized broad focus areas, including workforce, education, economic growth, infrastructure, quality of place and community health.

Phil GiaQuinta, D-Fort Wayne, House Minority Leader, responded to the Chamber's priorities, highlighting the need to address child care as a factor in economic development.

"We talk about economic development with things that impact economic development here in the state. Child care is really one of those," GiaQuinta contended.

The organization stressed the critical role of affordable child care in workforce development, citing a report estimating Indiana loses $4.2 billion annually, including $1.7 billion in tax revenue due to child care challenges. High costs force some parents out of the workforce, straining the state's economy.

Statehouse leaders acknowledged the issue but differ on solutions. Democrats argued child care deserves more state investment, while Republican leaders believe the private sector should play a larger role.

Todd Huston, R-Fishers, Speaker of the House, said businesses should not expect the state to solve their child care problems entirely.

"They've done a lot of different things to try to support families and young families. We will continue to do that," Huston stated. "But I think we also have to set a level of expectations that we're not going to; the state's not going to be funding all universal pre-K."

The Chamber plans to release detailed policy proposals in January, aiming to guide lawmakers toward strategies to strengthen Indiana's economy and workforce.


get more stories like this via email

North Dakota is no stranger to public pension debates. States face pressure to keep retirement systems well-funded and new data show most Americans place great value on such benefits for both government and private-sector workers.

According to the National Institute on Retirement Security, 86% of Americans believe all workers, not just those employed by state and local governments, should have a pension. There are similar approval levels when asked how important public pensions are in recruiting teachers and public safety workers.

Dan Doonan, executive director of the institute, suggested it is not too surprising to see the results.

"Pensions, along with other benefits, are part of creating that culture of careers and not jobs," Doonan explained.

Starting in January, North Dakota will close its main public pension plan for new hires, who will instead be offered a 401(k)-style benefit. The move followed debate over whether it was the right way to address a $1.9 billion unfunded liability. Backers argued it protects benefits for existing workers and taxpayers but skeptics contended it makes it harder to attract workers to the public sector.

Doonan noted the survey results overlap with the idea maintaining an experienced public-sector workforce is a good thing for community members and not just the employee and employer.

"In general, when public services are done well, they're often invisible, right?" Doonan emphasized. "We want good roads, we want safe communities, and I think Americans understand the role of having career public servants in terms of delivering those outcomes."

The Bureau of Labor Statistics said state and local governments employ about 20 million workers, which represents about 13% of the U.S. workforce.

As Nebraskans anticipate the upcoming holiday season, some might also be looking ahead to the 2025 tax season, which will include a new tax credit for family caregivers, including those looking after military veterans.

Starting in 2025, a new state law provides eligible family caregivers up to $2,000 in tax credits for out-of-pocket expenses. The cap increases to $3,000 if the family member receiving care has dementia or is a veteran.

Jina Ragland, associate state director of advocacy and outreach for AARP Nebraska, said those who served have access to care benefits through the Department of Veterans Affairs but added it sometimes is not enough.

"Because some of their service-related illnesses or injuries, they extend beyond what they're able to afford, or maybe what the coverage is through the VA," Ragland explained.

She pointed out it puts more pressure on loved ones assisting them on a daily basis. During National Veterans and Military Families Month, supporters of the new law hope more families will see if they are eligible. Ragland noted while it helps reduce the financial strain, greater awareness of resources is also needed, to help all family caregivers avoid burnout.

Ragland emphasized one example is providing caregivers information about where to turn for guidance when a loved one is first discharged from a hospital. She argued entities at all levels need to maintain progress, because their outreach shows a demand for solutions.

"Over 90% of Nebraskans say that they want to age in place with the lowest level of care," Ragland reported. "In order to do that, oftentimes we have to rely on family caregivers."

There are no age restrictions to qualify for the tax credit. As for eligibility factors, the law includes an income limit of $50,000 dollars for individuals and $100,000 for married couples.