26 Jun Study Finds that States are Expanding Home and Community Based Services
On October 25, 2018, the Kaiser Family Foundation issued a report entitled “States Focus on Quality and Outcomes Amid Waiver Changes: Results from a 50-State Medicaid Budget Survey for State Fiscal Years 2018 and 2019.” A copy of the full report can be accessed here. The report details the findings of a survey of Medicaid officials in all 50 states and the District of Columbia. The survey asked Medicaid directors in all 50 states and DC about Medicaid spending, enrollment and policymaking. The results of the survey revealed, among other things, that most states are expanding their home and community-based services (HCBS) programs under Medicaid. This is good news for HCBS providers across the nation and for those providers considering becoming HCBS providers under their state’s Medicaid program.
According to the report, “Medicaid covers one in five Americans, accounts for one in six dollars spent on health care in the United States, and makes up more than half of all spending on long-term services and supports.” Medicaid programs are funded by a combination of state and federal funds. Many providers of long-term care depend on funding from Medicaid to stay in business.
The survey found that in fiscal year 2018 46 states were employing one or more strategies to expand the number of people receiving HCBS under their state Medicaid program. The survey also found that in fiscal year 2019, 48 states had either started or were planning to employ strategies and measures to increase the number of people that receive HCBS under Medicaid. In 2018, only 3 states (Missouri, Montana, and Oregon) implemented benefit changes that reduced the number of HCBS beneficiaries and in 2019 only 2 states (DC and Montana) implemented such changes.
The survey also revealed that many Medicaid directors are aware of the caregiver shortage that is plaguing most home care agencies. The report states that, “low wages, few benefits, limited opportunities for career advancement, inadequate training, and high rates of worker injury are factors” in both the shortage of home care workers and in the high turnover rate of home care workers. As most home care agency owners know, hiring and retaining qualified caregivers is the number one challenge they face. Some states are implementing workforce development activities to help attract and retain caregivers.
For example, North Carolina has implemented a live-in caregiver program that allows a caregiver to move into a beneficiary’s home or allows a recipient to move into a caregiver’s home to receive care. Tennessee is making public funds available to create new education and training curriculum for direct care workers, where individuals will be able to earn college credit, complete a post-secondary certificate, and apply credits toward a new Associate’s degree. All-in-all, 12 states had workforce development strategies in place in 2018 and another 10 states had plans to implement strategies in 2019.
The report also reminds that the Money Follows the Person (MFP) program which was created in 2005 by Congress ended in 2016. This federal grant program supported the transition of over 75,151 individuals from institutional to home and community-based long-term care settings. Although states that received grants through the MFP program have until 2020 to spend all of the funds, some states reported that they had already expended the MFP funds and were cutting programs formerly funded by the MFP grant.
According to the report, in 2018, 49 states increased Medicaid waiver provider rates for at least one type of provider while 38 states restricted rates for at least one type of provider. 32 states increased rates for HCBS providers in 2018 while only 2 states restricted HCBS providers’ rates. In 2019, 47 states plan a rate increase for at least one type of provider while 31 states plan a rate restriction for at least one type of provider. Therefore, there are at least some states that are planning rate increases for some types of providers while planning reductions or restrictions in rates for others.
The report concludes that good economic conditions in the United States during fiscal years 2018 and 2019 have allowed states to expand coverage under Medicaid, especially in the HCBS arena. The report also notes that a number of state Medicaid programs are facing difficulty complying with new federal regulations, especially mandatory electronic visit verification and face-to-face documentation requirements for home health. The report also determined that many states are focusing on quality services and increasing positive outcomes for Medicaid recipients.
Now is a good time for providers that are not Medicaid waiver HCBS providers to consider enrolling in their state Medicaid program. However, before you enroll your agency, make sure your agency has the resources to comply with the complex web of regulations and requirements imposed by Medicaid.
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