Home Health & Hospice Week

Medicaid rates are far too low to support the policy.

The news about the Medicaid 80-20 rule is dire, but at least providers have more time to deal with it — or get it scuttled.

On April 22, Vice President Harris announced the final rule’s release, after publishing the proposed version of the Ensuring Access to Medicaid Services rule a year ago. The final rule includes a number of provisions, but the big one for home- and community-based care service providers is the one requiring that 80 percent of HCBS providers’ reimbursement rates must go to direct care workers. The other provisions include implementing a new HCBS quality measure set and new policies for states on rate-setting and other transparencies.

The final rule “will help improve access to home care services,” according to a White House release. It “will ensure adequate compensation for home care workers by requiring that at least 80 percent of Medicaid payments for home care services go to workers’ wages,” it says. “Higher wages will likely reduce turnover, leading to higher quality of care for older adults and people with disabilities across the nation,” the White House expects.

“This is about dignity,” VP Harris said at a roundtable discussion with healthcare workers in La Crosse, Wis., the day of the rule’s release. “It’s about the dignity that we as a society owe, to those in particular, those who care for the least,” Harris said, the La Crosse Tribune newspaper reports.

“Our caregivers — those who are taking care of the ones we love — deserve our respect and full support,” says HHS Secretary Xavier Becerra in a Centers for Medicare & Medicaid Services release about the final rule. “This will help ensure that millions of people have access to high-quality health care and that the dedicated workers who provide care to our loved ones are fully valued for their work.”

The rule, as well as ones implementing nursing home staffing minimums and Medicaid managed care changes released the same day, strive to make sure “coverage connects people to consistently high-quality care, regardless of where they live or receive care,” CMS Administrator Chiquita Brooks-LaSure says in the release. That goal aims “to ensure millions of people have access to affordable, quality health coverage and can stay healthy and thrive,” Brooks-LaSure stresses.

Rule Will Make Recruitment Even Harder

While the Biden Administration extolls the benefits of the rule scheduled for publication in the May 10 Federal Register, home care representatives beg to differ.

The National Association for Home Care & Hospice is “extremely disappointed” at the final rule’s lack of changes. “This is a misguided policy that will result in agency closures, force providers to exit the Medicaid program, and will ultimately make access issues worse around the country,” NAHC blasts in a release.

The 80-20 policy “is not only unworkable due to the varied nature of Medicaid programs across the country, CMS also lacks statutory authority to impose this mandate,” NAHC insists.

“Workforce challenges are a critical issue,” stresses LeadingAge CEO Katie Smith Sloan in a release. “Without staff, there is no care.”

This final rule will exacerbate instead of alleviate the problem, Smith Sloan argues. And “there is no guarantee that this rule will increase worker compensation,” she says.

“This policy will make things worse, not better,” NAHC President William Dombi criticizes.

“We know that CMS has good intentions and a desire to improve the lives of workers, but this policy is ill-advised and will have serious negative impacts on providers and their clients around the country,” NAHC Medicaid Advisory Council co-chair Jennifer Sheets says in the NAHC release.

“It is disappointing that this one provision will undermine all the good things about the rule,” BAYADA Hearts for Home Care’s David Totaro adds in the release.

“We are disappointed that HHS elected to keep the 80 percent payment threshold in place, despite over 2,000 comment letters to HHS from our industry … which pointed out the significant challenges implementing such a provision would create,” Addus HomeCare Corp. CEO Dirk Allison says in a release. “A nationwide ‘one size fits all’ minimum threshold is contradictory to the goal of ensuring access to Medicaid services, given the wide variance in state waiver programs, which directly affects the administrative burden in individual states,” Allison maintains.

The rule’s “most significant negative impact” will fall “on smaller providers and the beneficiaries they serve,” Allison warns. “These providers lack the scale and technological capabilities to operate under these requirements and implementation could lead to further industry consolidation,” he says.