Tuesday, February 28, 2023

States Strive to Help SNAP Recipients Cope With Lower Benefits -- on Stateline.org Feb. 28, 2023



States Strive to Help SNAP Recipients Cope With Lower Benefits

STATELINE ARTICLE February 28, 2023

By: Marsha Mercer 

Jaqueline Benitez shops for groceries at a supermarket in Bellflower, Calif., this month. Benitez, a preschool teacher, depends on California's SNAP benefits to help pay for food, and starting in March, she expects a significant cut, perhaps half, of the food benefits she has received since 2020. Many recipients nationwide also face cuts as pandemic aid ends.

Allison Dinner The Associated Press

The white words on a red background are plain. “Important notice: SNAP emergency allotments ending after February.”

If there’s any doubt, the Colorado Department of Human Services SNAP webpage adds, “All Coloradans who receive SNAP benefits are going to see a reduction in their monthly benefit amount after February.”

In every state, participants in the Supplemental Nutrition Assistance Program, commonly known as food stamps, face the loss of pandemic-related benefits in March, if they haven’t already lost them. States, community groups and food banks are scrambling to help families cope and gear up for an expected wave of food hardship.

“People are scared. They’re anxious. This is a devastating change,” Karla Maraccini, director of the Food and Energy Assistance Division of the Colorado Department of Human Services, told Stateline. “We want to make sure nobody is caught off guard in March.”

Colorado has a new, toll-free SNAP phone line and its SNAP website includes tips for the transition and a Food Finder link to locate the closest food pantry.

The average SNAP participant in states that still had emergency allotments as of February will receive $90 less a month in benefits, according to an analysis by the Center on Budget and Policy Priorities, a left-leaning think tank.

“We’re saying these families face a hunger cliff — more hardship and more food insecurity. People don’t have a cushion,” Ellen Vollinger, SNAP director for the Food Research and Action Center, an anti-hunger advocacy group, told Stateline.  

In March 2020, as COVID-19 swept the nation and the economy shut down, Congress gave states the authority to ease application and eligibility requirements for SNAP and to hike benefits with temporary emergency allotments.

The allotments were expected to last for the duration of the federal public health emergency in states that also had declared a public health emergency. But Congress in December passed a bipartisan federal spending package that ended SNAP allotments as of February 2023.

By the end of last year, 17 states had dropped state public health emergency status, meaning SNAP recipients in those states no longer received extra benefits.

The end of the federal public health emergency, recently set for May 11, will trigger other changes in SNAP that lower some benefits. Plus, Republicans in Congress are eyeing SNAP for potential cuts in the debt limit debate. The federal government pays for all SNAP benefits.

The spending package that ended the allotments early also established a permanent Summer Electronic Benefit Transfer for Children food service program. Families eligible for free or reduced-price school lunches will receive a monthly $40 grocery benefit per child when school is out starting in 2024.

The Summer EBT program is “the most significant new nationwide nutrition program in the last 50 years,” according to Vince Hall, chief government relations officer at Feeding America, the nation’s largest domestic anti-hunger network. But, he said, “as critical as it is, it is not a replacement for solving the nutritional needs of the whole family.”

STATELINE STORY February 13, 2023

States Scramble to Replace Ripped-Off SNAP Benefits


More than 41 million people purchased food with SNAP benefits last year, up from about 36 million in 2019, and the emergency allotments represented a huge inflow of federal funds to states.

In recent months, nearly $3 billion a month in additional benefits went to the states where the allotments were still in effect, according to the Center on Budget and Policy Priorities.

“I’m not aware of any state trying to replace the emergency allotments,” said Ed Bolen, director of SNAP State Strategies at the center.

The end of the allotments comes as state legislatures are in session and legislators are writing budgets for the next fiscal year, and a few states are taking steps to lessen the impact of lower benefits. But so far, New Jersey is the only state this year to enact SNAP legislation, according to the National Conference of State Legislatures.

The Garden State has twice raised the monthly minimum SNAP benefit — to $50 last year and to $95 this year. In most states, the regular monthly minimum SNAP benefit is $23 — and that’s after increases in 2021 and 2022.  

The new minimum benefit in New Jersey mostly will help older people and those with disabilities, whose incomes have risen due to cost-of-living increases in Social Security, said Carlos Rodriguez, president and CEO of the Community Food Bank of New Jersey. A higher income leads to a decrease in SNAP benefits.

His organization, which distributed food for more than 86 million meals last year, is preparing for increased demand by buying more food at higher costs because of inflation.

A household survey in December by Propel, a company that makes software SNAP recipients use to track their benefits and other financial products, found that 30% of respondents visited a food pantry in the last 30 days in states where emergency allotments were no longer being issued, compared with 22% of respondents in states still issuing emergency allotments.

In 2023 so far, lawmakers in 27 states and the District of Columbia have introduced at least 131 bills to strengthen SNAP by expanding access to the program, decreasing food and nutrition-related costs and providing emergency food aid, according to the conference of state legislatures.

A bill introduced Feb. 15 in California would establish a $50 state minimum benefit in the CalFresh program by January 2025. CalFresh is California’s SNAP program.

Last year, Maryland raised the minimum monthly SNAP benefit to $40 for those 62 and older. It was one of a dozen states that enacted 24 laws aimed at expanding or enhancing SNAP, according to the conference of state legislatures.

Atlanta Food Bank's Hunger Action Center


More States Are Forgoing Extra Federal Food Aid


In January, Massachusetts Democratic Gov. Maura Healey proposed spending $130 million to provide a bridge for more than 630,000 Massachusetts families, who would receive a supplemental allotment equal to 40% of the federal benefit for three months.

The array of state and federal safety-net programs, often with different eligibility rules, can be bewildering, so states are urging people to seek help determining the benefits for which they qualify.

North Carolina, for example, is encouraging pregnant women and mothers to sign up for the Women, Infants and Children food program. In addition, the statewide NCCare360 network is available to connect North Carolinians to health care, employment, housing and social services.

“We know even though the emergency allotments are coming to an end, the need is still there,” said Madhu Vulimiri, deputy director of the Division of Child and Family Well-Being in the North Carolina Department of Health and Human Services, which oversees the SNAP program.

The bottom line: “People will have less money to spend at the grocery store,” said Effie Rorke, senior director of public policy and communications at Feeding Colorado, the state association for Colorado’s five food banks, adding the need for food remained high throughout the pandemic.

“We serve a lot of people who are working or don’t get enough hours. Often food is the only item where they have a little wiggle room,” she said.

The Food Bank of the Rockies’ 800 members serve about half a million people a year over a wide swath of Colorado and all of Wyoming.

“We’re not fully meeting the need now,” said Erin Pulling, president and CEO of the Food Bank of the Rockies. She and her partners are ramping up food purchases, donations and fundraising and lobbying the state for more resources.

Thinking of the end of the allotments, Princess Mack, 53, of Aurora, Colorado, who shops with SNAP benefits for herself and two teenage daughters, said, “Does it make me nervous? It does.”

Before the extra benefits, she regularly visited a food pantry — something she hasn’t needed to do in years. But she’s prepared to go back.

“I’m not as panicky as some,” she said.

Tuesday, February 7, 2023

States Strive to Reverse Shortage of Paramedics, EMTs -- on STATELINE, Feb. 6, 2023

SOURCE: https://bit.ly/3DKBNaI



States Strive to Reverse Shortage of Paramedics, EMTs

Note: This story was updated, February 6, 2023, to clarify the capabilities of emergency medical responders who have completed the first level of training in Louisiana’s Jump Start program.

Low wages, a lack of work-life balance and burnout are among factors driving emergency medical services personnel around the country to quit ambulance duty.

Last year, the turnover rate for full-time emergency medical technicians, known as EMTs, was 36% and for full-time paramedics, it was 27%, according to an American Ambulance Association survey. The turnover rate includes both resignations and firings, but nearly all of the EMTs and paramedics who left did so voluntarily. More than one-third of new hires don’t last through their first year, the survey found.

A federal study projected a need for 40,000 more full-time emergency medical personnel from 2016 to 2030.

“The public doesn’t see where there’s no one in the station, and volunteer services are trying to muster a crew,” said Dia Gainor, executive director of the National Association of State EMS Officials and former director of the Idaho EMS office for 19 years.

When people call 911 to report a crisis — be it a car crash, drowning, shooting, difficulty breathing, heart attack, fall, stroke or drug overdose — emergency medical clinicians often are first on the scene to treat and transport the patient to the hospital. Agencies also transfer patients between hospitals.

To stave off longer 911 call wait times and the closure of ambulance services, many states are rethinking how they recruit and retain both paid and volunteer EMS workers. Nearly 40 state legislatures and Washington, D.C., considered bills in 2022 related to various aspects of emergency medical services, according to the National Conference of State Legislatures.

One idea is to expand the EMS workforce pool by age. As states felt the workforce pinch and began looking for younger clinicians, the National Registry of Emergency Medical Technicians, which tests and certifies EMTs, in 2019 eliminated any age requirement for certification. It had been 18.

At least six states have lowered the minimum age for EMT training to 16 or 17, according to NCSL. New Jersey, for example, allows 16-year-olds to enroll in training with parental consent. Indiana passed a law last year to allow retired emergency service personnel and some students to qualify for temporary licenses.

Louisiana is among states that offer EMS training classes in high schools. The Jump Start program started in 2015 and, by 2019, had led to the state licensing of 2,000 emergency medical responders, who have completed the first level of training and can provide immediate life-saving care until EMTs arrive on the scene. The program has also trained dozens of licensed EMTs, who can drive and care for patients in the ambulance, according to a report by the Louisiana Bureau of EMS.

“I’ve always liked medical stuff,” said Trentin Monk of Elizabeth, Louisiana, 16, who said his dream job is to become a flight paramedic, or a paramedic who works in an air ambulance. Last year at age 15 and as a sophomore in high school, he became the youngest certified EMT ever in Louisiana.

After Monk was certified nationally and had two rides in the ambulance, though, the fire department said he was too young to ride because of insurance rules. He volunteered for a few months longer but quit when he got tired of sitting around and not going on calls. He’s still glad he took the classes and the exam.

“It’s a good thing to put on my resume,” he said, adding he plans to return to EMT duties when he turns 18.

Most metropolitan EMS agencies in Louisiana choose not to hire employees under the age of 21 for insurance purposes, but many rural EMS agencies and fire departments will hire people over the age of 18, according to the state EMS report, which said applicants who already have a state license have an advantage in the hiring process.

Kelly Grayson, a critical care paramedic and owner of the consulting business MEDIC Training Solutions, was Monk’s EMT teacher.

“Getting high school kids into the training program hasn’t alleviated the shortage, but it’s a start,” Grayson said, adding it can be better than trying to recruit people already in the workforce. “The idea is to start them young and keep them in EMS for a longer period of time.”

Fire and EMS personnel, with the help of Washington, D.C., police, transport a man feeling the effects of synthetic drugs to an ambulance. Overdose patients have at least a 1 in 10 chance of dying from a subsequent incident in the following year.

A New Paramedic Policy May Guide Overdose Patients Into Treatment

Licensed by the states, EMTs and paramedics work full- or part-time or volunteer in city or county rescue squads and fire stations, separate EMS stations and private ambulance companies, as well as in hospitals and clinics. The biggest difference between EMTs and paramedics is their training and scope of work.

An EMT needs no previous medical background before training, but to become a paramedic, one needs to be an EMT before training.

Bruce Evans, then-president of the National Association of Emergency Medical Technicians, told a congressional panel last February the association’s EMT and paramedic members respond to nearly 28.5 million emergency calls each year.

“Currently, our nation’s EMS system is facing a crippling workforce shortage, a long-term problem that has been building for more than a decade but made significantly worse by the pandemic. Most communities are facing crisis-level shortages of EMS personnel and many communities have been impacted by agency closures,” Evans testified at a Senate subcommittee hearing on health care workforce shortages.

While workers in other fields have been able to work from home during the coronavirus pandemic, EMTs and paramedics continued to respond to 911 calls and go into people’s homes during early days, before vaccines were available or scientists fully understood how COVID-19 spread. Some clinicians quit because they were afraid of bringing the virus home to their family members; others couldn’t keep up with the additional hours required to take up the slack, officials said.

The ambulance workforce shortage comes even though more EMS clinicians are being certified nationwide. There were 456,366 certified EMS workers in 2021, an increase of 5% and 20,200 people from the year before, according to the National Registry of Emergency Medical Technicians.

“Like all health care, there is a workforce shortage, but with emergency medical services, it’s also a placement, a distribution problem,” Susan Bailey, current president of the National Association of Emergency Medical Technicians and director of the Louisiana Bureau of Emergency Medical Services, said in an interview.

“Since COVID-19, hospitals have found value in EMTs and paramedics, and they’ve started hiring them at competitive salaries,” she said. “It takes them out of the ambulance and into the hospital.”

Ambulance agencies can’t pay more because the federal reimbursement rate for ambulance services has not kept pace with the costs, she said. The Center for Medicare and Medicaid Services is evaluating a pilot program with a new fee payment model that could lead to changes in the ambulance reimbursement structure.

Pay and benefits were a top concern of EMS workers who responded to the EMT association’s 2022 workforce satisfaction study, but the inability to balance work demands with family responsibilities edged out pay as the primary reason people said they were leaving their jobs. More than half of the respondents said they worked two or more jobs to make ends meet.

Two of five EMTs said they made less than $15 an hour; about half the paramedics, who have more training, made $21 to $30 an hour, the workforce satisfaction study reported.

Workforce challenges are particularly acute in rural areas that rely on volunteers to respond to 911 ambulance calls.

Jules Scadden, a paramedic for 30 years, is director of emergency medical services at Dysart Ambulance Service in central Iowa. Dysart is a city of 1,379 people about 20 miles south of Waterloo, where the nearest hospitals are.

Dysart’s two ambulances cover a service area of 150 square miles and run about 200 calls a year. The service had about 24 workers on the roster pre-pandemic and now is down to 20. Except for Scadden and two other employees, the rest are volunteers.

“I’m fortunate because even with a small roster, we’re able to keep the ambulance staffed 24/7,” she said. Time was when volunteers could show up for calls as they were available; now volunteers are scheduled. At one time, local schools allowed staff to leave school to take ambulance calls, but that’s no longer the case.

If it’s hard to keep volunteers, it’s as difficult to hire paid staff, she said.

“In my little, small rural area, we cannot afford to pay what bigger cities can pay. New people want the big city; they want the call volumes.”

Medical workers fill a hallway in the acute care unit, where about half the patients are COVID-19 positive or in quarantine after exposure, of Harborview Medical Center, Friday, Jan. 14, 2022, in Seattle. Washington

Health Worker Shortage Forces States to Scramble

However, Texas found that in the first eight months of 2021, only 27% of state-licensed emergency medical services personnel submitted a patient care record, which is required for patients who receive care in an ambulance. That means more than 70% of licensed EMS professionals were not working in ambulances, said the Texas EMS Alliance, which represents EMS agencies in the state, citing Texas Department of State Health Services data.

Texas Gov. Greg Abbott, a Republican, signed a $21.7 million measure in November 2021 funded by federal COVID-19 relief funds to expand awareness of EMS careers, provide tuition scholarships for EMS training and ramp up other recruitment and retention efforts.

States also are studying how to maintain EMS systems. A commission in Maine issued a 51-page report in December that recommends the state spend $70 million annually for five years to avert an emergency medical crisis that stems in part from a lack of volunteers.

The Colorado legislature, noting that some Coloradans “no longer have access to a Colorado-based emergency medical services system, and other Colorado communities are at risk of losing” theirs, set up a task force to study long-term EMS sustainability.

In New Hampshire, Democratic state Sen. Suzanne Prentiss, a paramedic, suggested to state Commissioner of Safety Robert Quinn that he convene an ad-hoc committee to study EMS workforce and other issues, and he did.

Among the committee’s dozens of recommendations: End New Hampshire’s requirement that EMS workers be U.S. citizens, develop a plan to recruit people of more diversity in race, ethnicity and gender and develop a more active social presence.

“Be more inclusive — that’s what we need to do,” Prentiss said in an interview. “Entire groups of people just don’t see themselves in these roles and don’t know how to get into the profession. We can do better in New Hampshire.”