​​Congress is in the middle of a contentious budget process that could have major implications for home care providers. Both the House and Senate have passed their respective versions of a Fiscal Year 2026 budget resolution. The House now expected to consider the Senate’s version. 

In a 53-45 vote along party lines last week, the Senate confirmed the nomination of Dr. Mehmet Oz as administrator for the Centers for Medicare and Medicaid Services (CMS).

The Urban Institute, in partnership with the Robert Wood Johnson Foundation, recently published a study illustrating the financial impact on states when federal funding received per Medicaid enrollee is limited and eliminating the Federal Medical Assistance Percentage (FMAP), which expanded eligibility for state Medicaid programs. It was found that reducing federal Medicaid spending in these ways would make it difficult for states to maintain their current Medicaid programs. To cope, states may need to raise taxes, cut spending in other areas like education, reduce payment rates for providers, or lower benefits for Medicaid enrollees.

HCAOA is closely monitoring potential Medicaid cuts that could occur through the budget process. The U.S. House of Representatives recently proposed a budget resolution that requires the Energy and Commerce Committee, which oversees Medicaid, to identify at least $880 billion in mandatory spending cuts over the next 10 years. It would be challenging for the committee to make such a significant cut in spending without cutting Medicaid. These proposed cuts have raised concerns within the home care community, as Medicaid is a crucial funding source for many of our members and the clients they serve.

Medicaid home care faces ongoing workforce challenges, impacting over 4.5 million users of home- and community-based services (HCBS). Many states are addressing this by increasing payment rates, according to a recent issue brief released by KFF. The survey was sent to each state official overseeing home care benefits (including home health, personal care, and waiver services for specific populations, such as people with physical disabilities). All states except Florida, Indiana, and Utah responded.

The HCAOA Hawaii Chapter recently submitted testimony in support of HB 702. This bill highlights a significant wage gap for direct care workers, as shown by the Milliman rate study, which emphasizes the need to increase payment rates to stabilize care access. HCAOA fully supports HB 702, noting that the data from the study is five years old, and costs have dramatically risen since then. To address wage pressures and improve access to care for Medicaid clients, funding the rate study at the higher scenario in the Milliman study is crucial.

​Connecticut Governor Lamont introduced a two-year budget proposal that would fund an additional special investigator in the Department of Consumer Protection (DCP) and add funding for home care waiver services in the Department of Social Services (DSS).

​HCAOA member Right at Home has partnered with PocketRN to support dementia patients through the Centers for Medicare & Medicaid Services (CMS) Guiding an Improved Dementia Experience (GUIDE) model. This collaboration offers Right at Home clients access to PocketRN's "virtual nurse for life" system, which provides continuous nurse-led education, coaching, monitoring, and support. It also allows Right at Home to offer respite care services, a feature of the GUIDE model.

A minimum wage increase to $16/hour in Nevada, which took effect in January 2024, has helped reduce turnover among home care workers, with the state’s home care workforce growing by 6.5% and 96% of workers being retained between December 2023 and April 2024. Additionally, Nevada raised its Medicaid reimbursement rate from $17.56 to $25 per hour to better support home care providers as the state’s aging population continues to grow.

The Center for Medicare & Medicaid Services (CMS) recently updated the Medicaid eligibility standards for 2025, which reflects a 2.9% price increase between 2023 and 2024.

The Connecticut Department of Social Services (DSS) reported that, due to staffing issues and the complexity of the technical requirements, it plans to delay until April 1, full implementation of the home care provider registry and data processing system.

A new study published in the JAMA Health Forum reveals that the Medicaid "unwinding" process, which resulted in the disenrollment of approximately 15% of beneficiaries since March 2023, has created significant barriers to accessing home care services for seniors. Researchers surveyed 843 community-dwelling seniors who lost or had to renew their Medicaid eligibility, finding that many reported cost-related delays or forgoing care, especially for dental and home health services. Additionally, about half of the respondents received no information about the unwinding process, and many faced difficulties navigating the renewal procedure. The study emphasizes the need for better outreach and support to help seniors retain Medicaid coverage and reduce care access barriers, particularly for those who lost coverage due to procedural issues.

The Connecticut Department of Social Services (DSS) issued the final report of a two-part study of Medicaid reimbursement rates. The report recommends that DSS examine the current process for assessing home and community-based services (HCBS) waiver members and consider adoption of standardized and validated tools that could provide a comprehensive assessment of functional needs, natural supports, and level of acuity.

Pennsylvania Medicaid Home & Community Based Services (HCBS) Rates have been updated and take effect January 1, 2025.