STATE POLICY -- 2021

Iowa direct care workers include home health aides and direct care workers, staff in nursing homes and hospitals, and others providing services to enable seniors and persons with disabilities and chronic health conditions to live in dignity and continue contributing to society.

Currently, most of those employed in these caregiving roles rely upon public funding for much of their work, often through Medicaid and its home and community-based services. The state is responsible for registering and overseeing this workforce and its quality. By how it reimburses for such services, the state also effectively sets parameters on the salaries and benefits workers receive.

These workers historically have been predominantly women, with low levels of compensation and limited employment benefits, including access to health care. The Iowa Caregivers Association represents many in this workforce, and its research shows the need to better compensate and support this workforce, particularly in light of Iowa's aging population. 

These workers have been essential to responding to COVID-19, but COVID-19 also has shown the precarious nature of this workforce, even as the demand for them grows.

The Iowa Helping Community Policy Group is seeking to elevate attention to them in state policy making -- both through supporting HF692, upgrading Iowa's registry, and through developing a comprehensive and inclusion implementation infrastructure for making use of federal funding to support this workforce, as described in HCR8.

Iowa administers the federal child care development block grant and provides additional state funding, as well as using funding from the temporary assistance to needy families block grant. Iowa lawmakers expanded child care eligibility to more working families.

Iowa's current  reimbursement for child care, however, results in child care workers being among the lowest paid occupations in society and COVID-19 has placed many child care centers and family child development homes at risk, causing many to close.

The Governor established a child care working group within Iowa Workforce Development to develop long-range plans for building a robust child care workforce to meet Iowa needs, with broad support from Iowa employers as well as the child care workforce.

In addition, Iowa has established a voluntary universal preschool program for four-year olds. Federal proposals to provide voluntary universal preschool for both three- and four-year olds are designed to build upon state programs like Iowa's voluntary preschool program.

As President Biden has emphasized the importance of "building back better" and developing a twenty-first century caregiving and education workforce, Governor Kim Reynolds has proposed complementary actions at the state level. In her Vision for Iowa, Governor Reynolds stated:

  "Iowa’s economic recovery plan is about

more than yesterday’s goals. It’s a new opportunity to build a better Iowa, elevate how we do business, modernize  how we work and learn, and further improve our quality of life.” 

–- Vision for Iowa: Preparing a Future Ready Iowa

Governor Reynolds included specific emphasis upon both child care and health care within that vision:

•“One of the most significant barriers to entering the workforce is the availability and affordability of child care. … The child care crisis is not only affecting families, it’s impacting the state’s workforce at a time when Iowa is missing out on nearly $675 million in annual GDP because of a shortage of employees.” 

•“Health care the way it exists today may not be sustainable in some areas. But with change comes the opportunity to create a more integrated, coordinated system promoting the health and wellness of every Iowan.  … The Governor acknowledges the importance of home and community-based care for aging and disabled individuals, and the difference these services make in maintaining health and quality of life.“

In March, the Iowa Helping Community Policy Group reached out to all members of the General Assembly to encourage them to recognize and work to advance state policies related to the helping community, particularly as embodied in HCR8, which the Group helped develop and promote. That document also went to state officials, included the text from HCR8, and is provided in the resource section. 

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In May, the Group followed up with specific recommendations for action related to both HCR8 and HF692, with an emphasis upon setting up a review and oversight process during the legislative interim/ That document also is in the resources section.

The Group is planning further policy maker education activities over the legislative interim and further development of policy proposals for the 2022 legislative session, including those related to state implementation of federal  policies and investments and development of an essential worker bill of rights to guide state action. 

In particular, the Group is calling for concerted and inclusive planning and dialogue on this workforce, actively engaging the frontline workforce and the people they serve, in order to design implementation strategies for building a more robust workforce to meet Iowa's needs.

The Policy Group then developed a 2022 agenda (see resources) and 18 senators introduced Senate Concurrent Resolution 104 that sets a broad direction for state action to support the helping community. The policy update (see resources) has a link to resolution.

The Iowa Helping Community Policy Group reached out to the Governor's office and different state agencies and has made several presentations to state policy leaders.

This has included Iowa Workforce Development and its particular work around Future Ready Iowa and its work group on child care. Currently, since the legislation establishing Future Ready Iowa directed its focus to advancing employment in jobs with compensation above the median income level, direct care workers and caregivers have not been part of the focus. The Policy Group is seeking commensurate attention to this direct care workforce as a core part of the Iowa economy.

The Iowa Department of Human Services has sought public input into the state's use of additional funding through the American Rescue Plan Act related to home and community-based services. The request for submission of comments, along with the statutory provisions and federal guidelines for use of the funds, is provided in the resources section.