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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

Arkansas House Passes Premium Assistance Alternative to Medicaid Expansion Previously Endorsed by CMS

April 16, 2013 03:49 PM

On April 16, the Arkansas House passed a bill incorporating premium assistance as an alternative to Medicaid expansion.  This follows a Q & A released March 29, in which Centers for Medicare & Medicaid Services (CMS) stated that it would consider Arkansas’ and other states plans to expand Medicaid via premium assistance.  Therefore, CMS will give federal matching funds to states that expand health insurance coverage to 133 percent of the federal poverty level via premium assistance, so long as the premium assistance demonstrates cost effectiveness and other stipulations.  Premium assistance refers to when a state uses Medicaid funds to pay for private insurance premiums for adults and children otherwise eligible under Medicaid.  

State Plan Or Demonstration

CMS gives states the option to adopt premium assistance via either a state plan or a section 1115 demonstration project. 

Cost Effectiveness

CMS stipulates that premium assistance must be “cost effective,” i.e. that the total cost of the premium, additional services, and cost sharing assistance is “comparable” to traditional Medicaid costs.  For premium assistance demonstration project proposals, CMS would take into account not only cost-effectiveness, but also “actuarial, economic, and budget justification (including budget neutrality).”

“Wrap Around” Private Coverage

In addition, CMS requires that states have “mechanisms” to “‘wrap around’ private coverage” when such private coverage has less benefits and greater cost sharing requirements than Medicaid. 

Coverage Alternatives

FCMS also requires that the beneficiaries have the ability to select an alternative to private insurance.  CMS requires that all premium assistance demonstrations provide at least two qualified health plans (QHPs) for beneficiaries to choose from.  


Much remains to be seen with premium assistance programs.  Despite the recent passage of the Arkansas bill promoting such a model – known as “the Arkansas Model” - in the Arkansas House, full details of the Arkansas Model have yet to emerge. Additionally, the Obama Administration has yet to formally approve the Arkansas Model, and specific private insurance carriers have yet to be named. It also remains unclear whether home health services will be covered. 

Despite all the uncertainty surrounding the Arkansas Model, home health providers can look to premium support as a potential opportunity for increased reimbursements 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, especially given its recent passage in the Arkansas House, may be an indication of things to come.  Home health providers are encouraged to contact NAHC with any questions or concerns.

To see CMS’ full Q & A on premium assistance, click here.

To see the relevant section in the Arkansas bill, see the Health Care Independence Act of 2013, beginning on page 16, here.





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