Fact Sheet Now Available on Proposed Medicaid 80/20 Proposed Rule

8/23/2023

HCAOA continues efforts to highlight the negative impact of CMS’ proposed rule that would require states to ensure at least 80 percent of all Medicaid HCBS payments are spent on compensation for direct care workers, such as nurses, home health aides, and others who directly support Medicaid beneficiaries in activities of daily living at home. The remaining 20 percent of payments would be expected to cover all other HCBS operating expenses.

Last month, HCAOA and NAHC submitted comments on the rule in a 75-page document that emphasized the industry’s support to increase wages of direct care workers but challenged the 80/20 proposal citing a lack of data to support and implement the proposal, particularly in rural areas.

A fact sheet is now available, highlighting several state Medicaid officials’ comments and opposition to the rule. Members are encouraged to use the fact sheet in advocacy efforts to oppose this rule.

20 Comments

Elena

8/23/2023 11:12:53 am

Good day, thank you for allowing me to share my opinion about the funding. Each state has a different income and the budget. Each state is subsidies differently. The rule of the 80% is a risk factor for many elderly and disabled. Some of the elderly have a spend down or a a low monthly retirement that is not enough to cover expenses not to mention the HomeCare inquiry. Did you know that sending the seniors to the rehabs and nursing homes will over charge the state’s and federal budget? Most of the seniors are born and worked in United States. They paid their taxes to the government so others can rely on their need . Not it’s your mission to pay them respect and subsidize their needs they deserve. The social service theme must stay humanity and fair. We all vote for our taxes to support the economy and social services and NOT the war. I oppose the idea of the states to pay the 80% .. what if CT can and other states cannot? Each state is booming with the baby boomer growth. The social service is key ! The care at home is vital! I hope that the lawmakers have guts to stand up for the hard working and disabled people. Seniors are vulnerable. Has a democratic value changed its’ course?

Home Care Association of America

8/23/2023 01:29:10 pm

Hi Elena, thank you for sharing your opinion with us. We will certainly incorporate your comment into our advocacy moving forward. If you want to discuss this further, HCAOA's CEO, Vicki Hoak, has invited you to contact her at [email protected].

C Jackson link

8/30/2024 08:46:13 am

I own a small Homecare Agency in Pittsburgh Pa. If we are forced to follow this 80/20 rule we will be closed down along with hundreds of other homecare agency's in our area. Then there will be thousands of consumers not being serviced. There is already a shortage on aides because no one wants to work after the pandemic. We are already paying the max that we can afford just to get aides in the door. We spent our companies entire ppp loan on giving out bonuses to the employees who worked through the pandemic. Then we had to take out another loan just to compete with the big companies and offer sign on bonuses because we weren't getting any new hires. The 80/20 will defiantly make me close down!!!

cynthia sertuche

5/1/2024 02:40:21 am

I'm an individual with a father that has worked his whole life cuz he grew up poor y'all are talking about Medicaid he doesn't even qualify for Medicaid he has Medicare and the best supplement insurance and still cannot get help I'm going 6 years he's got dementia Parkinson's Alzheimer's congested heart failure and afib and I cannot get MediCare at all Medicare not Medicaid because he doesn't qualify for Medicaid to help but we pay $600 a month for our benefits to have them and it's supposed to be the best of the best but I can't get anybody at Medicare that knows anything about the skilled maintenance program for chronic illness diseases that are until longevity of their life they keep sending me people for Rehab which is really destroying him and the on the website there is nothing about clinical diseases you know illnesses for Life long term y'all are talking about insurance and all this my father has insurance but because he works so hard to provide for his kid which is me I'm his only child I can't get any help because he was poor and he saved and he wanted to make sure he had a good retirement y'all want us to sell everything so that he can get Medicaid to get help I think that's BS that's not fair we work all of our lives so that we can retire and have something and Medicare is supposed to take care of them especially cuz he's a vet and nothing I mean he's dying without the help for Medicare and he wants to be home so think about that when you're doing all this about Medicaid and the programs I mean y'all do Medicaid for pregnant people and so forth what about our elderly y'all just let them go y'all want to cut their their money their checks their services their benefits I mean most of these people were out saving the world for us and y'all just have no animosity or no gratitude that's horrible but if you went out and save the world would you like this and one day everybody's going to get old and they're not going to have anything because of this reevaluate think you're going to get old one day and if you don't have this and no one tells you that you need long-term life you know figure Medicare cover everything plus a supplement and if Medicare doesn't approve it then supplement doesn't either 6 years or six hundred dollars a month and nothing and you talk to $50 million different people that know nothing and Medicare and I was told they don't know nothing about it Medicare doesn't pay it Google it you'll find it I said that's your job they tell me no it's not cuz we don't know anything about it that's sad very sad it's important that was actually a management person insubordinate people that don't give a damn about people that have really saved their lives I'm really upset with that and no one wants to do anything about the seniors that are living on the street that and this is because my father is not a service related but he still served why is he any different than anyone else I mean I understand service related yes but I mean still it's terrible and then Social Security told me that because of his age that he didn't qualify because he was going to die there was other people that could utilize it really that is something something it's horrible

Stephen Tweed link

8/23/2023 02:25:49 pm

Data gathered from our research at Leading Home Care, along with our member benchmarking at the Home Care CEO Forum suggest that this new rule will create unintended consequences for state Medicaid Programs, as home care providers will be unable to sustain operations and keep caregivers employed.

The proposed 80% rule will cut gross margins for home care companies to the point that many companies, particularly smaller companies, will stop providing care to Medicaid beneficiaries. In many areas of the country, beneficiaries are already being turned down for care because local agencies cannot find caregivers to staff the cases.

We appreciate the work that HCAOA is doing to communicate with legislators and regulators on this issue, and also what you are doing to address the caregiver shortage. Thank you.

8/23/2023 02:58:37 pm

Thank you for your support of HCAOA, Stephen. Your comment will be included into our advocacy as well.

Jason Tweed link

8/23/2023 03:47:57 pm

The Proposed 80/20 rule is irresponsible and dangerous in my opinion. Almost no agencies could be profitable with only 25% markup above cost, and even those that could squeak out a profit, it would be fractional compared to the potential profits of private pay home care. No agency in their right mind we continue to provide services to Medicaid waiver clients. The 80/20 rule would only be viable for self-directed care, putting the onus and risk directly on the shoulders of the users and their families. It's hard enough to find high quality care when you have the benefit of professionals supporting you. As a user of home care services I am vehemently opposed to this proposed change.

Edward

8/24/2023 12:35:12 pm

Is the 80% allocated for 'compensation for direct care workers' inclusive of benefits and FICA tax contributions?

8/24/2023 03:24:55 pm

Hello Edward, Great question. Taxes would be included however, benefits such as insurance, Workers’ Compensation would NOT be included and would have to come out of the remaining 20%. If you have additional questions or would like to speak with someone directly please don't hesitate to contact HCAOA at [email protected] and we will get back to you.

8/24/2023 04:26:04 pm

Thanks

Dawn Douglas link

11/29/2023 11:19:03 am

If this bill passes, most agencies will stop accepting medicaid clients, which will end in complete disaster for the vulnerable population who desperately need assistanct at home. We already have families calling our office in tears, because they can't get the help they need for their loved one. CMS is not factoring in Workmans comp, General Liability, Professional Liability and unemployment taxes that home care companies need to pay, on top of the wages to the employee. The waiting list for Medicaid clients is already at an all time high. If this bill is passed, that list will triple. I have had discussions with many other agencies in the area, and they all said the same thing. They will not accept Medicaid if the bill is passed, because they would not be able to afford to keep their doors open.

Sejla Maksumic

4/18/2024 05:45:22 am

I strongly oppose to this rule. First and foremost Medicaid participants will loose care they need in order to remain in their homes. Most will end up in a nursing homes which will be very hard on the states as well to pay for nursing home facilities. Another issue is agencies are reaponsible for paying EVV system, CDS annual audits, workmen's comp, general liability, professional liability, dishonesty bond, unemployment taxes, CDS taxes, IRS taxes, state taxes...and it all comes out of agency budget. None of these necessities are reimbursed. This rule will only bring fall of the agencies and hardship on our seniors and people with disabilities.

Rebecca Wolfe link

4/22/2024 07:21:31 pm

I would like to say that i also strongly oppose this 80/20 ruling. Although i'm in agreement that our states caregivers have got to be able to make a much more liveable wage ,But what good is it going to be to provide home care to those that will no longer have homes? The seniors on social security don't make enough to support themselves now, as you can see with the growing homeless problem in this country .So now the idea is to take more away from them? No ..In no way shape or form is this a good idea. Come on guys. DO BETTER!

Patrick Ford

4/22/2024 09:57:18 pm

Yes this is not well thought out. A small company that does 1 million a year with Medicaid would have to spend 800,000 to nurses, and aids. That leaves 200,000 to cover expenses. That’s not even possible because workers comp, rents, utilities, and other office needs would eat up 150,000 which leaves the business with earning 50,000.00. That will basically take out the smaller agencies and only agencies with 10 or more offices would be in a position to profit.

Ibrahim Austy

4/22/2024 10:32:48 pm

What I see here is actually a 80/20/-10 rule: 80% for the care worker, 20% for employment expenses, utilities, rent,… and -10% for the Agency, meaning agencies are now subject to contribute for Medicaid. CMS just needs to do calculations not only writing texts, that will make things easy for them!!!! They can also open an Agency and experiment their 80/20 to see clear.

Beth Bigham link

4/23/2024 09:50:52 am

I was part of the task force to help my state what rates for home care should be - by sharing our costs. It went up 11.08. They broke down % of expenses for everything. I am sure all states do this. Have they asked the experts? NO ONE can sustain operating a home care company with paying 80% to caregiver wages. We need to admin bodies to operate. States require so much from us. We have admin support to fulfill tasked requirements, to keep caregivers and clients safe at home

Judith Loubier link

4/23/2024 10:13:05 am

As a home care owner in NH currently providing services to individuals covered by Medicaid, this would add us to the group of home care operators who have already dropped Medicaid clients. NH is in a challenging time as an aging state with few home care workers. We have a very competitive rate of pay but given the caregiver shortage, we would not be able to use caregivers for Medicaid clients and forgo private pay clients due to lack of staff. There is no doubt that this rule has put the most vulnerable at greater risk.

John Hughes

4/23/2024 07:58:44 pm

I do not know of a single agency that can pay all of their expenses with only 20% of the revenue. As many others have mentioned, you have overhead for office staff, insurance, rent, utilities, etc. My state requires an RN on staff for oversight purposes although we do NOT get paid for the RN by Medicaid even though it is a requirement of our state license. CMS seems to be good at creating rules, but have no idea what it's like to run a business, especially a home care business.

Kimberly Elaine Ross

5/22/2024 01:43:57 pm

CMS has been working hard to expand and shift money into home and community based services while decreasing spending on LTC.
One result is fewer available LTC beds. Now that they have successfully expanded home and community based services they are "surprised" by the increased spending in home and community based care. Now what can they do? Tell the public that Providers are greedy and can't be trusted to pay DSW a reasonable wage then implement the 80/20 plan which they KNOW will force HCBS Providers out of business ( as they did previously with LTC providers) and create an environment in which patients can't access the HCBS they need and there aren't enough LTC Providers to pick up the slack because CMS collapsed that market the LAST time they expanded HCBS. Patients will begin over-utilizing Acute Care because it is the only remaining source of care. The rise in Acute Care spending will "surprise" CMS and they will launch new initiatives to reduce Acute Care spending. How? By expanding HCBS and the HCBS Provider network. During every cycle of poor access DMS saves money. When there are no providers to pay families suffer but CMS makes out like a bandit. This constant cycle of creating and destroying access to care helps keep CMS solvent.
While this may seem like nothing more than a cynical conspiracy theory the only other explanation is that CMS is incapable of critically examining the last 100 years of cyclical behavior and recognizing how their decisions create and sustain those cycles.

Michael W

6/6/2024 09:20:29 pm

The main goal of the 80/20 rule is to increase wages? What if I told you many of my associates would actually have a decrease in their annual salary because of this rule? Why? We are already on the forefront of competitive wages, by not only offering the highest hourly rate but also a large amount of overtime hours which we make zero profit on. Increase the hourly wage would make overtime impossible as the time-and-a-half amount would be far too high. As a result overtime would no longer exist and we would be forced to find additional staff, which can't be found, to cover hours that were previously covered but now aren't, while the primary CNA makes less than before. This 80/20 rule also destroys holidays and sundays where time-and-a-half is mandatory. If this is implemented not only will it not achieve it's aim, it will destroy the entire industry while simultaneously saving the insurance companies millions, if not billions in costs to provide care. I'll pray the people who implemented this never need the service they are intending to destroy.

Fact Sheet Now Available on Proposed Medicaid 80/20 Proposed Rule

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