Urgent Advocacy Update...CMS Finalized 80/20 Rule

As expected, the Centers for Medicare and Medicaid Services (CMS) finalized their Medicaid Access Rule today. Among many other things, the rule includes a problematic provision that mandates that 80 percent of Medicaid reimbursement dollars paid to providers be allocated to caregiver wages. Although HCAOA supports certain aspects of this rule, the 80/20 provision will cause many Medicaid providers to either curtail services or cease providing services entirely, resulting in reduced patient access.

We find the 80/20 provision within the rule problematic for a number of reasons:

• It 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 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 rule.
• We cannot get enough caregivers as it is. Although the Administration is attempting to assist with 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 as it 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 provision. Several state agencies provided formal comments in opposition to the rule for that reason.

 
Now that the rule has been finalized, HCAOA will continue to educate Members of Congress about the harmful impacts of the 80/20 provision with the goal of addressing those concerns. During last week's HCAOA National Home Care Advocacy Day attended by over 110 participants, the 80/20 provision was one of the key priorities discussed with Members of Congress and their staffs. Additionally, we should note that HCAOA and the home care industry are planning to exhaust all options in our fight to ensure Medicaid services remain available and affordable to all those who need them.

More details about the rule will be forthcoming once it is published in the Federal Register. We will continue to provide you with updates.
 
For more information about HCAOA's position on the Medicaid Access 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.