Medicaid Home and Community-Based Services (HCBS) offer essential state and federally funded services to provide Medicaid enrollees with the supports they need to continue living in their homes in lieu of institutional settings. States elect the HCBS services offered, establish eligibility criteria, set rates for care providers, and overall manage their HCBS programs.
The Centers for Medicare and Medicaid Services (CMS) recently issued the Medicaid Program: Ensuring Access to Medicaid Services proposed rule (“Medicaid Access Rule”), which includes a HCBS Payment Adequacy proposal to require that states 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. PMHC along with many states, providers, and organizations recognize the severe workforce crisis in our industry which has only added to the waiting lists for these services. However, we have all expressed concern that this specific HCBS Payment Adequacy proposal would only further harm access as it is unfunded, not supported by data, and would require significant shifts in available resources. We urge CMS to remove this proposal from the final rule and work with all stakeholders to create evidence-based solutions to our severe workforce crisis and help uplift our services and the beneficiaries that depend on them.
Impact of the Medicaid Access Rule
The Partnership for Medicaid Home-Based Care (PMHC) found in a survey of mostly smaller home care/personal care service providers that if the 80/20 threshold was finalized:
- 55% of the provider agencies be forced to close their doors [exit the market] while 35% of agencies would narrow service offerings or geographies served.
- Over 93% of providers surveyed would be limited in their ability to take on new referrals.
- In order to meet the threshold, providers would make cuts to non-direct care staff (coordinators and other essential staff), clinical oversight, and training amongst other cuts. Several providers would also stop serving Medicaid recipients.
- Over 90% of providers would face challenges serving more administratively costly rural populations and 86% of providers would be impacted negatively in serving underserved populations.
The Home Care Association of America (HCAOA) found in a survey of their home care/personal care service provider members (also a majority smaller providers responded) that if the 80/20 threshold was finalized:
- A majority of providers serving Medicaid beneficiaries would exit the Medicaid program and focus on other payors.
- Over 60% of home care providers would have their ability reduced to serve rural communities and over 64% of home care providers would be impacted negatively in serving underserved populations.
The American Association of Community Options and Resources (ANCOR) found in a survey of providers of services for people with intellectual and developmental disabilities (I/DD) that:
- 81% of respondents indicated that the HCBS Payment Adequacy provision would negatively impact their ability to provide services.
- 79% of respondents indicated that the HCBS Payment Adequacy provision would negatively impact the quality of services provided.
- 84% of respondents indicated that they were concerned that the HCBS Payment Adequacy provision would reduce access to services.
Documents & Letters
In The NewS
- CMS Press Release
- Home-Based Care Providers Break Down “Unintended Consequences” of CMS’ Proposed Medicaid Rule
- CMS Medicaid Proposals Offer Transparency and Accountability, But Compensation Provision Could Cap Business For Cash-Strapped Providers
- CMS’ spending requirement in HCBS rule “not the right approach,” senior living advocates say
- Providers need funding to improve Medicaid HCBS access, quality, advocates say