Senate Bill Seeks to Expand Medicaid Coverage of Home and Community-based Care

Prior to leaving for the August Congressional recess, Senators John Kerry (D-MA) and Charles Grassley (R-IA) introduced the “Empowered at Home Act” (S. 3327 <http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.03327:> <blocked::http://thomas.loc.gov/cgi-bin/bdquery/z?d110:s.03327:>  ), a bill that seeks to increase access to home and community based services by giving states new tools and incentives to make these services more available to those in need.

In a statement upon introduction of the bill, Kerry said, “Far too many elderly or disabled Americans can’t get the help they need in their home and community. Home- and community-based services are high-quality, cost-effective, and help many people live independent lives, but Medicaid continues to favor nursing homes. It’s a problem when the nation’s largest purchaser of long-term care services is tilted towards nursing homes rather than home and community based services. This bill will level the playing field and give families real choices to care for their loved ones, and give cash-strapped states new tools to provide cost-effective long-term care options to the most vulnerable.”

“Being able to live at home greatly improves quality of life because people can be with loved ones and have the dignity that goes with greater independence,” said Grassley. “This bill encourages states to help make that possible, which is also fiscally smart because institutional care is the most expensive form of long-term care that Medicaid pays for. This bill also empowers individuals to manage the financial burdens that come with caregiving needs.”

The bill has four basic parts:

1.      It seeks to improve the Medicaid Home and Community-based Services (HCBS) State Plan Amendment Option by giving states more flexibility in determining eligibility for which services they can offer under the program, creating greater options for individuals in need of home and community-based services, and providing some additional funding to assist states in making the transition. It would establish parity in income eligibility standards for home and community based services and institutional care at 300 percent of the Supplemental Security Income (SSI) level ($22,932/year). In return states could no longer cap enrollment and would have to offer services throughout the entire state.
2.      It would require that the same spousal impoverishment protections offered for new nursing home beneficiaries be in place for those opting for home and community based services. In addition, low-income recipients of home and community based services would be able to keep more of their assets when they become eligible for Medicaid, allowing them to stay in their community longer.
3.      It would offer tax-related provisions to support family caregivers and promote the purchase of private long-term care insurance.
4.      It would provide grants for states to invest in organizations and systems to help ensure a sufficient supply of high quality workers, promote health, and transform home and community based care to be more consumer-centered.
Section 201 of the bill would provide grants that states could use to create one or more statewide or regional public entities or non-profit organizations to address workforce issues, including training, screening, and taking on many of the responsibilities of the employer of home care workers. Although the legislation does recognize “the multiple delivery options that take into account differing needs of individuals” and ensures that consumers would not be restricted to hiring workers from such entities, the creation of these entities (sometimes referred to as public authorities) would be a cause for concern by many home and community-based providers and consumers. Such public authorities can result in discouraging home care aides from working for home care agencies or consumers from obtaining home care aides services through agencies. In its Legislative Blueprint for Action, the National Association for Home Care & Hospice (NAHC) maintains that consumers should have the right to choose to receive home care aide services according to the delivery model that they are most comfortable with. In addition, home care aides should have the opportunity to choose their employer. Home care agencies are better equipped than public authorities to provide worker training, screening, and oversight.

Serena L. Brock