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.

9 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 vicki@hcaoa.org.

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 info@hcaoa.org 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.

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

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