With the termination of pandemic-driven Medicaid funding by the federal government, states are now confronted with the responsibility of covering the expenses for Medicaid long-term services and supports (LTSS), which includes home- and community-based services (HCBS). The Federal Medical Assistance Percentage (FMAP), supplemented federal Medicaid funding to states, is scheduled to phase out next month under the Consolidated Appropriations Act of 2023. A report by KFF anticipates that to compensate for this reduction in funds, state Medicaid spending is estimated to surge by more than 17% in the coming year.
HCAOA encourages all providers considering the Guiding an Improved Dementia Experience (GUIDE) Model to thoroughly assess its financial feasibility.
It is crucial for home care providers to carefully evaluate the associated expenses tied to participating in the GUIDE Model. This includes the costs of providing in-home respite care and conducting in-person face-to-face live assessments, both mandated components of the GUIDE Model. Furthermore, assessing the financial implications helps home care providers determine whether the GUIDE Model allows for profitability under the payment rates set by the Center for Medicare & Medicaid Services (CMS). This evaluation is critical in determining if implementing the GUIDE Model allows your business to meet its financial goals and is sustainable for your home care agency.
HCAOA Washington Chapter Addresses Exclusion of Family-Funded Home Care Providers in WA Cares Act Funding
Recently, the Washington LTSS Trust Commission recommended (see slide 27) that family-funded home care providers be excluded from accessing WA Cares Act funding if they do not have a contract to provide Medicaid services. HCAOA and its Washington Chapter submitted a letter to the Commission expressing its vehement disagreement with the proposal, which you may read by clicking here.
On October 10, it was announced all 10 drug companies selected for Medicare Drug Pricing Negotiations Program'sfirst cycle have opted to participate. These companies manufacture some of the most expensive and commonly used prescription drugs. These selected drugs accounted for $50.5 billion in total Part D gross covered prescription drug costs, representing about 20% of the total Part D gross covered prescription drug costs between June 1, 2022, and May 31, 2023. Medicare enrollees taking these 10 drugs paid a total of $3.4 billion in out-of-pocket costs in 2022.
AARP's Long-Term Services and Supports (LTSS) 2023 State Scorecard Report was just released and reveals significant gaps in the care provided to older adults and individuals with disabilities in the United States. Although there has been some overall progress compared to the 2020 update, every state still has areas that require improvement.
The U.S. Department of Health and Human Services (HHS) has successfully reenrolled nearly half a million children and families in Medicaid and Children’s Health Insurance (CHIP) coverage, fixing an error that was causing improper disenrollment. The Centers for Medicare & Medicaid Services (CMS) identified a state systems issue that was improperly disenrolling individuals, even when they remained eligible based on available information. CMS stated that measures were in place that would prevent further improper disenrollments.
A recent analysis by the Kaiser Family Foundation (KFF) warns that the termination of payments to family caregivers, which were allowed during the COVID-19 pandemic, may intensify workforce shortages in Medicaid home- and community-based services (HCBS). Over 4 million individuals rely on Medicaid HCBS, making it a vital program for elderly and disabled Americans. Medicaid spent approximately $162 billion on HCBS in 2020, out of a total of $245 billion in HCBS spending, as Medicare generally does not cover these services.
CMS has addressed operational issues causing people to lose their Medicaid coverage during the federal unwinding period. CMS identified problems with how certain states auto-renew enrollees at the family level rather than the individual level, potentially leading to the improper disenrollment of eligible individuals when family members don't qualify for coverage. In response, CMS has mandated that affected states pause procedural terminations for those improperly disenrolled, reinstate their coverage, switch to individual-level auto-renewals, and implement strategies to mitigate further issues, such as extending Medicaid eligibility for affected families up to a year after their scheduled renewal period. CMS aims to rectify flaws in a renewal process that has resulted in millions of individuals losing Medicaid coverage because of the end of COVID-19 eligibility requirements.
Representative Jesse Petrea has forwarded an update that he received earlier today concerning the approaching deadline of September 15th for all Medicaid providers to revalidate their credentials. This revalidation process must be completed to assure that providers continue to receive their Medicaid reimbursements for services rendered to Medicaid members.
Join Vicki Hoak, HCAOA’s CEO, on Thursday, September 21, 2023, at 12:00 p.m. ET for a webinar discussing trends in home care mergers and acquisitions. She will be joined by colleagues from Polsinelli and the National Association for Home Care & Hospice.
During this webinar, attendees will hear from active buyers who will share their experiences in home care agency acquisition transactions and discuss their criteria when targeting agencies for acquisition. The webinar will also cover the mechanics of a home-based care transaction, covering various transaction types and options, the legal framework of a deal, regulatory considerations, pitfalls in the diligence process, and essential steps agency owners should take to prepare their agency for sale.
Assistant Secretary for Planning and Evaluation (ASPE): Understanding the Growing Demand for Long-Term Services and Support
The aging U.S. population is expected to increase the demand for long-term services and supports (LTSS), much of which is currently provided by informal caregivers. However, for those requiring paid LTSS, most Americans rely on personal funds and then turn to Medicaid once their resources are depleted. This reliance on Medicaid for individuals with limited income and assets could increase federal and state spending on LTSS. To address this concern, a project was initiated to analyze the current cost of long-term care, national expenditures on LTSS, and future predictions regarding the availability of informal caregivers. The project explores how demographic changes will impact the supply of informal caregivers for older Americans. One of the project's primary goals is to provide updated estimates of national LTSS expenditures and projections that illustrate how changing demographics may affect the demand for LTSS, the availability of future caregivers, and Medicaid spending.
Krystal Wilkinson, HCAOA Arizona Chapter Chair and President of Adultcare Assistance (second from right), and Stephanie Roberts, Policy Leader with Team Services Group (left), recently met with two Arizona state representatives, Rep. Patty Contreras (D-12) and Rep. Judy Schwiebert (D-2), to discuss home-based care issues, including Medicaid reimbursement rates and how to ensure safety in home care in Arizona.
An article entitled, “Price of elder care soars as demand increases, baby boomers age,” was published on TheHill.com on August 13, 2023. The article discusses how the cost of caring for aging or ailing family members in the U.S. has risen dramatically in recent years in nursing homes, assisted living facilities, and adult day centers. With insufficient support from programs like Medicare and Medicaid, many family caregivers are forced to deplete their limited funds to cover expenses.
Alaska recently passed legislation (SB.57) to expand home care access for aging adults and others requiring assistance with daily living through a new Medicaid service called "adult home care,” expected to affect 2,500 residents. Signed into law on July 29 as part of the governor's Healthy Families Initiative, the option will enable more individuals to receive medical and personal care at home rather than having to move into costlier institutional settings like nursing homes. The law is part of Alaska's efforts to improve health equity and meet the needs of older adults within their communities.