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By MICHAEL MARTZ, Richmond Times-Dispatch 
 RICHMOND, Va. (AP) — Joyce Barnes has become sick before by caring for someone who was carrying a communicable disease without anyone knowing it — a bacterial infection that put her in the hospital last year.
 The coronavirus pandemic has raised the stakes for Barnes, 61, who cares for Medicaid patients in their homes but does not have health insurance or paid sick leave or hazard pay to care for herself if she contracts COVID-19.
 Barnes, who lives in Sandston in eastern Henrico County, makes $9.40 an hour as a personal care attendant for people who otherwise would have to go to nursing homes. An elderly man incapacitated by stroke. Another who has lost both legs to diabetes.
 “I love the one-on-one work, but it’s just sad that with predominantly Black women working in these jobs, we don’t get what we deserve,” she said. “I feel like we are the forgotten ones.”
 Their plight has gotten the attention of Gov. Ralph Northam, who protected a 5% wage increase for personal care attendants in the two-year state budget that took effect on July 1. The increase represents an additional 47 cents an hour in the average wage for attendants in Virginia.
 The state also is preparing to distribute an initial shipment of 30,000 cloth masks to Medicaid recipients to share with the attendants they employ in the “consumer-directed” home care program — a belated effort to begin providing personal protective equipment, or PPE, to workers on the front line of the COVID-19 crisis.
 “They send you out to do a job and you’re not prepared or equipped to do what you’re supposed to do,” Barnes said.
 The Department of Medical Assistance Services, which runs the Medicaid program in Virginia, is packaging the first shipment of masks to distribute to Medicaid recipients who receive home care. Each will receive five masks for themselves and their attendants. The agency said it expects to complete the delivery of cloth masks to the remaining program recipients this week.
 The state also has promised to provide protective gloves, disposable masks and hand sanitizer for 30,000 home health workers who it estimates care for nearly 25,000 Medicaid recipients in Virginia.
 “We hope to have those supplies later this month,” spokeswoman Christina Nuckols said July 2.
 “It’s an important step to recognize the PPE needs of home care workers,” said David Broder, president of Service Employees International Union Virginia 512, which represents personal care attendants.
 But Northam has not yet acted on requests for up to 16 hours a week in overtime — a budget provision that the governor and General Assembly froze because of the economic fallout of the health emergency — as well as paid sick leave and hazard pay for workers.
 “Every day I pray and ask God to protect me,” Barnes said. “If I come down with something, at my age, I know it’s going to be bad.”
 Deputy Secretary of Finance Joe Flores said the Northam administration recognizes the need.
 “These folks are underpaid and they’re the ones going in and doing the work. This is tough work,” Flores said.
 Almost all of Virginia’s personal care attendants are women and more than half are African American, according to a 2017 survey by PHI National. They earn an average wage of $9.40 an hour statewide and $12.17 an hour in Northern Virginia, where living costs are higher.
 The attendants allow elderly and disabled Virginians to remain in their homes by helping them with the essential activities of daily living — feeding, dressing, bathing, walking.
 “Home care workers cannot practice social distancing in the workplace, and they cannot stop going to work,” House Appropriations Chairman Luke Torian, D-Prince William, wrote to Northam last month in support of a request for aid by the SEIU.
 “Not only do their patients rely on their care, but the low pay does not facilitate an unpaid leave of absence,” Torian told the governor.
 The budget committee chairman is a member of the Virginia Legislative Black Caucus, which also has urged Northam to support requests for ongoing and emergency relief to personal care attendants.
 “Home care workers are part of the commonwealth’s strategy, even in normal times, to keep some elderly and disabled Medicaid recipients in their homes to receive care instead of over-burdening and adding pressure to the brick-and-mortar health care system,” the caucus said in a letter from Chairman Lamont Bagby, D-Henrico, to the governor in early May.
 The role of home care, through consumer-directed attendants or home health agency employees, has become more critical in a public health crisis that has ravaged nursing homes and assisted living facilities.
 Through the morning of July 1, the Virginia Department of Health had documented 240 coronavirus outbreaks in long-term care facilities that have resulted in 6,862 confirmed cases of COVID-19 and 1,077 deaths — 60% of the 1,786 Virginians who have died from the disease during the pandemic.
 “We should be doing everything possible to keep them out of nursing homes,” said Broder at SEIU.
 Restoring a budget provision to allow overtime pay under Medicaid is one of the union’s priorities. Northam protected the pay increase — 5% this year and 2% the next — which will cost the state about $65 million, with an equal amount from the federal Medicaid program.
 But the overtime provision was among more than $2.1 billion in spending initiatives approved by the assembly in March but frozen the following month in response to the economic consequences of the public health emergency.
 The provision would remove the current cap of 40 hours a week for attendants, who would be able to work up to 56 hours a week. The provision would cost the state $19.2 million over two years.
 The union also is asking for up to 14 days of paid sick leave for attendants who work 20 or more hours a week, which would cover time for quarantine if they test positive for COVID-19. Two weeks of sick leave would cost the state $7.8 million a year, but SEIU said a fallback provision for five days of paid leave would cost $2.8 million.
 A proposal for hazard pay would be the biggest expense at $23.1 million, based on raising the hourly wage to $15 through the end of the year and retroactive to Northam’s stay-at-home order on April 1.
 The union argues that the federal CARES Act that Congress adopted and President Donald Trump signed into law in late March allows Virginia to use a portion of the $3.1 billion it received for state and local governments to pay for expenses to combat the coronavirus.
 Eligible expenses include payroll for essential employees whose jobs are “substantially dedicated” to the public health emergency, as well as paid sick and family leave for public employees.
 Supporters say higher pay will reduce the risk of spreading the virus by allowing attendants to survive financially with fewer clients.
 “Not being able to get by with one client puts the whole process at risk,” Broder said.
 Joyce Barnes has worked in home health care for more than 30 years, directly for Medicaid recipients and through home health agencies.
 Before the health emergency, she worked for three people, but cut back to two after the crisis began.
 “With the pandemic going on now, I’m very cautious,” she said. “I’m very scared.”

Virginia home health aides look for state relief in pandemic