HCAOA CEO Responds to President Biden's Care Economy Remarks

Yesterday, President Joe Biden provided remarks regarding the care economy, including home care, at a Washington, D.C. event with care workers. During his remarks, President Biden referenced the Centers for Medicare & Medicaid Services (CMS) 80/20 proposed rule, which would compel home- and community-based services (HCBS) providers to allocate 80 percent of Medicaid reimbursement to care worker wages. Although the Home Care Association of America (HCAOA) appreciates President Biden’s efforts to support home care, we find the 80/20 proposed rule problematic for a number of reasons.

The 80/20 provision prescribes how we may use current Medicaid funding rather than addressing the real workforce problem: the inadequacy of the rates themselves. They are far too low and leave us no leeway already. Encouraging states to increase the reimbursement rates and offering an enhanced Federal Medical Assistance Percentage (FMAP) is the most effective and efficient way to raise direct care worker (DCW) wages.
 
Restricting costs and prescribing rates at an arbitrary 80/20 ratio would contradict many of the quality measure efforts that we actively support in the proposed rule. This is a time when the industry needs more support and more innovation, not less funding and more regulation.
 
The negative impacts to patient access nationally will be swift and severe. Most providers will curtail services, while many will leave the Medicaid space entirely. 80/20 will only serve to reduce access, particularly in rural and underserved communities, contradicting the purported goal of the proposed rule.
 
We cannot get enough caregivers as it is. While the Administration is attempting to assist in this shortage, the imposition of this rule will only serve to further hamper our efforts to recruit and retain the caregiving workforce Americans rely on and deserve because this significant rule will force providers to cut the supports that they currently pay for out of their own pockets: services such as training, career advancement, supervision, and oversight and recognition programs. These are the things that support a thriving workforce.
 
Furthermore, each state has different rate methodologies that would be undermined by the 80/20 proposed rule. Several state agencies provided formal comments in opposition to the proposed rule for that reason.
 
For more information about HCAOA's position on the 80/20 proposed rule, please see HCAOA’s Fact Sheet and formal comments submitted to CMS in partnership with the National Association for Home Care & Hospice (NAHC) here.