To: Joint Finance Committee Co-Chairs Senator Howard Marklein and Representative Mark Born and Committee Members
From: Melissa Smart, President, Wisconsin Personal Services Association; msmart@smartchoicewi.com
Date: June 18, 2025
On behalf of the Wisconsin Personal Services Association (WPSA), the statewide association of personal care provider agencies, I am writing to ask for your support of a 48% increase to the Medicaid Personal Care Rate and increasing the nurse supervisory visit rate to $209 per visit.
Personal care services are in-home caregiving services that assist older adults and people with disabilities with things like getting out of bed, getting dressed, eating and bathing. This differs from care provided by CNAs or in nursing homes or assisted living.
Care provided in the community is 45% cheaper than institutional settings. The largest growth in Medicaid enrollment is in the “elderly group” which is projected to grow by 2.2% annually during the 2025-27 biennium. Wisconsin cannot address Medicaid cost-to-continue concerns without addressing the access issues to home and community-based services.
48% Increase to the Medicaid Personal Care Rate
The Medicaid Personal Care Rate, which is currently $24.52 per hour, supports all aspects of providing personal care services, including: personal care worker pay, a portion of registered nurse pay, benefits, worker’s comp, travel pay and pay differentials, electronic visit verification, supplies and more. The true cost of providing care is $36.52 per hour.
In our 2025 Workforce Survey, heard from over 70 personal care agencies, who employ over 4,500 direct care workers and provide care to over 5,400 individuals. They told us that:
- 1,578 direct care workers left WPSA agencies between 1/1/24 and 12/31/24.
- 75% have at least one open caregiver position each week.
- 41% turn away five (5) or more people in need of care each month.
- 50% have clients who’ve been unnecessarily hospitalized or could not be discharged
This data means that today in Wisconsin, someone will miss a meal, sleep in their wheelchair or spend hours in soiled clothing because there aren’t enough personal care workers to meet the needs of people who require assistance. Unfortunately, agencies can’t recruit and retain workers with the current reimbursement rate. Providers across the state report losing quality caregivers to Kwik Trip, Walmart and fast food locations that can offer higher wages.
Please increase the Medicaid Personal Care rate by 48% to achieve a rate that covers the true cost of care of $36.52. It is important to note that personal care is not currently an eligible service for the Family Care Direct Care Workforce Funding or the HCBS minimum fee schedule initiatives.
Nurse Supervisory Visit Rate Increase
Agencies currently receive $52.72 per visit for the costs associated with Registered Nurses (RNs) performing mandatory in-home supervisory visits of personal care workers. Medicaid regulations require RNs to conduct these visits every 50-60 days for each client. This includes scheduling appointments, performing assessments, travel and mileage costs, completion of the personal care screening tool, completion of the plan of care, coordinating physician documentation, and training personal care workers. The supervisory rate does not cover all RN costs and, as a result, a portion of the MAPC rate subsidizes RN services, eroding what agencies can pay personal care workers.
Agencies are struggling to recruit and retain RNs because the current supervisory visit rate does not even cover the cost of the visit. In addition, other required RN services, such as the personal care assessment are not reimbursed at their own rate and are covered by the MAPC rate, which then takes away from personal care worker pay. Without enough RNs, agencies cannot take on new clients in need of caregiving services. In addition to recruitment challenges, agencies now report RNs quitting due to the pandemic telehealth flexibilities coming to an end, which will require enhanced travel time and workload.
Please increase the current nurse supervisory visit so it covers the true cost of $209 per visit.
Thank you for your consideration and please don’t hesitate to contact me with any questions.
