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In the various roles he has undertaken through the years, Val J. Halamandaris has been a singular driving force behind the policy and program initiatives resulting in the recognition of home health care as a viable alternative to institutionalization. His dedication to consumer advocacy, which enhances the quality of life and dignity of those receiving home health care, merits VNA HealthCare Group’s highest recognition and deepest respect. 

VNA HealthCare Group

I have the highest respect for them, especially for the nurses, aides and therapists, who devote their lives to caring for people with disabilities, the infirm and dying Americans.  There are few more noble professions.

President Barack Obama

Home health care agencies do such a wonderful job in this country helping people to be able to remain at home and allowing them to receive services

U.S. Senator Debbie Stabenow (D-MI) Chair, Democratic Steering and Outreach Committee

Home care is a combination of compassion and efficiency.  It is less expensive than institutional care...but at the same time it is a more caring, human, intimate experience, and therefore it has a greater human’s a big mistake not to try to maximize it and find ways to give people the home care option over either nursing homes, hospitals or other institutions

Former Speaker of the U.S. House of Representatives Newt Gingrich (R-GA)

Medicaid covers long-term care, but only for low-income families.  And Medicare only pays for care that is connected to a hospital discharge....our health care system must cover these vital services...[and] we should promote home-based care, which most people prefer, instead of the institutional care that we emphasize now.

Former U.S. Senator Majority Leader Tom Daschle (D-CD)

We need incentives to...keep people in home health care settings...It’s dramatically less expensive than long term care.

U.S. Senator John McCain (R-AZ)


Home care is clearly the wave of the future. It’s clearly where patients want to be cared for. I come from an ethnic family and when a member of our family is severely ill, we would never consider taking them to get institutional care. That’s true of many families for both cultural and financial reasons. If patients have a choice of where they want to be cared for, where it’s done the right way, they choose home.

Donna Shalala, former Secretary of Health and Human Services

A couple of years ago, I spent a little bit of time with the National Association for Home Care & Hospice and its president, Val J. Halamandaris, and I was just blown away. What impressed me so much was that they talked about what they do as opposed to just the strategies of how to deal with Washington or Sacramento or Albany or whatever the case may be. Val is a fanatic about care, and it comes through in every way known to mankind. It comes through in the speakers he invites to their events; it comes through in all the stuff he shares.

Tom Peters, author of In Search of Excellence

Val’s home care organization brings thousands of caregivers together into a dynamic organization that provides them with valuable resources and tools to be even better in their important work. He helps them build self-esteem, which leads to self-motivation.

Mike Vance, former Dean of Disney and author of Think Out of the Box

Val is one of the greatest advocates for seniors in America. He goes beyond the call of duty every time.

Arthur S. Flemming, former Secretary of Health, Education, and Welfare

Val has brought the problems, the challenges, and the opportunities out in the open for everyone to look at. He is a visionary pointing the direction for us. 

Margaret (Peg) Cushman, Professor of Nursing and former President of the Visiting Nurses Association

Although Val has chosen to stay in the background, he deserves much of the credit for what was accomplished both at the U.S. Senate Special Committee on Aging, where he was closely associated with me and at the House Select Committee on Aging, where he was Congressman Claude Pepper’s senior counsel and closest advisor. He put together more hearings on the subject of aging, wrote more reports, drafted more bills, and had more influence on the direction of events than anyone before him or since.

Frank E. Moss, former U.S. Senator

Val’s most important contribution is pulling together all elements of home health care and being able to organize and energize the people involved in the industry.

Frank E. Moss, former U.S. Senator

Anyone working on health care issues in Congress knows the name Val J. Halamandaris.

Kathleen Gardner Cravedi, former Staff Director of the House Select Committee on Aging

Without your untiring support and active participation, the voices of people advocating meaningful and compassionate health care reform may not have been heard by national leaders.

Michael Sullivan, Former Executive Director, Indiana Association for Home Care

All of us have been members of many organizations and NAHC is simply the best there is. NAHC aspires to excellence in every respect; its staff has been repeatedly honored as the best in Washington; the organization lives by the highest values and has demonstrated a passionate interest in the well-being of patients and providers.

Elaine Stephens, Director of Home Care of Steward Home Care/Steward Health Systems and former NAHC C

Home care increasingly is one of the basic building blocks in the developing system of long-term care.  On both economic and recuperative bases, home health care will continue to grow as an essential service for individuals, for families and for the community as a whole.

Former U.S. Senator Olympia Snowe (R-ME)

NCOA is excited to be part of this great event and honored to have such influential award winners in the field of aging.

National Council of Aging

Health care at home…is something we need more of, not less of.  Let us make a commitment to preventive and long-term care.  Let us encourage home care as an alternative to nursing homes and give folks a little help to have their parents there.

Former President Bill Clinton

Tennessee Joins Several States in Supporting Arkansas Private Option as Substitute for Medicaid Expansion

April 4, 2013 04:27 PM

On April 2, Tennessee Governor Bill Haslam (R) stated that he is currently in negotiations with the federal government regarding an alternative plan to Medicaid expansion.  His plan would expand health care coverage to low income citizens with federal money by purchasing private insurance for these beneficiaries.  In an address to the Tennessee legislature on March 27, the governor formally rejected Medicaid expansion, and stated that specifically, his plan would:

  • Expand coverage through private health insurance to those currently uninsured earning up to 138 percent of the federal poverty level
  • Require co-payments for those who could afford to pay them
  • Include an end-date of the expansion, only to be extended with the legislature’s approval
  • Include a value-based compensation element. 

Governor Haslam stated that in negotiations with the federal government, differences remain that need to be resolved regarding copayments and wrap-around services.  Tennessee is one of at least ten states in which such a “private option” has gained traction.

The Arkansas Model

Also on April 2, Secretary of Health and Human Services Kathleen Sebelius sent Arkansas Governor Mike Beebe (D) a letter showing “conceptual support” on a “private option” with the Secretary, following a February 23 verbal agreement between the two parties.  Secretary Sebelius stated that she looks forward to receiving Beebe’s detailed demonstration proposal.  Instead of increasing the number of enrollees in Medicaid under the Affordable Care Act’s Medicaid expansion provisions, Arkansas will use federal Medicaid expansion money to purchase private insurance for Arkansans living below 138 percent of the federal poverty level through the health insurance exchange. 

Arkansas and Ohio are currently negotiating with the Obama Administration to formalize such a “private option” arrangement. The “private option” is gaining in popularity – with Republican lawmakers and governors in Florida, Louisiana, Maine, Missouri, Oklahoma, Pennsylvania, and Texas also expressing interest in similar coverage arrangements.  In order for the private option to become law in Arkansas, it must receive 75 percent of the state legislature’s vote.

Legal Precedent

Joan Alker, Co-Director of the Georgetown Center for Children and Families, stated that this “private option,” where states purchase private insurance to subsidize coverage, is also known as “premium assistance.”  Alker states that premium assistance is authorized under Sec. 1905(a) of the Social Security Act and is currently being implemented by a few states on a small scale.  In a Q & A released March 29, Centers for Medicare & Medicaid Services stated that it would consider states’ premium assistance demonstrations so long as they were budget neutral, among with other stipulations. 

To see the full Q & A, pleae click here.

Positives and Negatives

Those favoring the “private option” over traditional Medicaid expansion cite several points.  Some, including Representative Bill Cassidy (R-LA) - who is a physician - point to the greater efficiencies of private insurance over Medicaid. Beneficiaries could also have greater choice of coverage through a private option.  Additionally, providers would be more willing to accept private insurance than Medicaid, given the former’s likely higher reimbursement. 

According to Tami Luhby of, the beneficiaries would benefit from continuity of care, as they would be able to continue receiving coverage if their incomes increase above the Medicaid threshold, whereas those on the traditional Medicaid program would be dropped from Medicaid in similar circumstances.  This would avoid a Medicaid “churn,” i.e., enrollees dropping in and out of the Medicaid program, which would significantly reduce costs to states.  

A private insurance mode, however, also has setbacks.  The costs of private insurance tend to exceed those of Medicaid. The Congressional Budget Office estimated the per-person difference in cost to be $3,000.

See page 4 of the report here.

Given that the Obama Administration is asking Arkansas and Ohio to demonstrate that their private options are not more expensive than traditional Medicaid as a condition for formal approval, this could be problematic.  Robert Pear of the New York Times noted that Medicaid has strict provisions limiting copays and deductibles, and also provides many services that private insurance may not including: dental services, personal attendant services, long-term care, and medical equipment.

Legislative Landscape

Support is growing in several states other than Tennessee for adopting the Arkansas Model.  While Florida legislators are currently rejecting Medicaid expansion as proposed by Governor Rick Scott (R-FL), the Florida Senate has advanced a bill that would use Medicaid expansion funds to purchase private insurance for the expanded population. 

Although Texas Governor Rick Perry (R) officially declined to expand his state’s Medicaid program last July, State Senator Tommy Williams (R), chairman of the Senate Finance Committee, proposed a “Texas Solution” to increase coverage, which would include a private insurance component. 

Ohio’s House of Representatives are currently deliberating how to expand coverage - and are considering the Arkansas Model among others.  Governor Bobby Jindal’s (R-LA) Department of Health and Hospitals Secretary Bruce Greenstein stated that he was looking forward to hearing more about the details of the Arkansas Model, including how private insurance and the exchange were to be incorporated. 

Pennsylvania Governor Tom Corbett (R) publically stated that he could not support Medicaid expansion at this time, and met with Secretary Sebelius on April 2, where he also signaled an interest in the Arkansas Model.   


Much remains to be seen regarding the “private option.”  Details of the Arkansas Model have not yet been released, nor has the Arkansas legislature voted on it.  Additionally, the Obama Administration has yet to formally approve the Model, which may necessitate a waiver.  Specific private insurance carriers have yet to be named, and it remains unclear if home health services will be covered. 

Despite the uncertainty, home health providers can look to the Arkansas Model as potential opportunity for increased reimbursement that may surpass Medicaid rates.  However, commercial plans may also negotiate lower rates than Medicaid, as done in the past, in order to achieve budget neutrality.  Home health providers should continue to monitor the status of Medicaid expansion in their states.  The traction that the Arkansas Model has already garnered may be an indication of things to come.  Home health providers are encouraged to contact NAHC with any questions or concerns.




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