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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

Heath 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

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

Amenable to Premium Assistance, but not Partial Medicaid Expansion: How Flexible Will CMS Be?

April 19, 2013 11:53 AM

The Centers for Medicare and Medicaid Services (CMS) has issued two major Q & As regarding Medicaid expansion. In December 2012, CMS stated that it would not entertain a partial expansion less than 133% of the federal poverty level.  This month, it stated that it would consider premium assistance models as an alternate to Medicaid expansion. 

For the CMS guidance rejecting partial expansion, see page 12, here.  For a previous NAHC report article reporting on CMS’ recent guidance on premium assistance, click here.  Given these two Q & As, CMS seems poised to accept qualifying premium assistance models, but will oppose any partial Medicaid expansion legislation emanating from the states. 

Premium Assistance Models Progressing in States

The premium assistance alternative to Medicaid expansion scored a recent victory. On April 16 and 17, Arkansas passed a bill through both the Arkansas House and Senate supporting such an alternative.  Currently, the National Association for Home Care and Hospice has found thirteen (13) states that are in some way interested in the premium assistance model.  Seven of those states - Arkansas, Florida, Montana, Ohio, Pennsylvania, Tennessee, and Texas - are either negotiating with the federal government or proposing bills on premium assistance, while the other six states - Kansas, Louisiana, Maine, Missouri, Nebraska, and Oklahoma - are otherwise considering the model. 

As of April 17, Tennessee Gov. Bill Haslam (R) is still in negotiations with the federal government for a premium assistance option.  As stated in an address to the Tennessee legislature on March 27, his plan would: 1) expand coverage through private health insurance to those currently uninsured earning up to 138 percent of the federal poverty level; 2) require co-payments for those who could afford to pay them; 3) include an end date of the expansion, only to be extended with the legislature’s approval; and 4) include a value-based compensation element.  Mr. Haslam stated that in negotiations with the federal government, differences remain to be worked out regarding copayments and wrap-around services. 

On April 8, officials working for Pennsylvania Governor Tom Corbett (R) confirmed that Pennsylvania was in negotiations with the federal government for alternatives to Medicaid expansion, and that using premium assistance to expand coverage to 133% of the federal poverty level was one such option discussed.

On April 17, a Florida Senate committee passed Republican Senator Joe

Negron’s plan (the Negron Plan) that would provide premium assistance for uninsured Floridians earning up to 138% of the federal poverty level.

On April 16, Texas Representative John Zerwas (R) introduced a bill in the Texas House proposing a “Texas Solution” echoed by Senator Tommy Williams (R) to expand coverage using premium assistance.  The plan proposes to obtain premium assistance via three possible scenarios.  In order of preference, they are: 1) a block grant; 2) a waiver program; and 3) premium taxes collected on policies sold through the health insurance exchange.

On April 17, the Montana Senate voted to adopt a premium insurance model, and in Oklahoma, the state hired consultants to look into premium assistance, among other options.  The state is expecting the report from the consultants in June.

Cost Effectiveness a Significant Concern

Despite the momentum surrounding premium assistance, such plans must demonstrate cost effectiveness and budget neutrality in order to receive CMS approval.  This reality may serve to slow down and possibly reverse interest in premium assistance.

Alternative Florida Plan Pursues both Premium Assistance and Partial Expansion

Florida lawmakers, despite CMS’ explicit rejection of a partial expansion, continue to propose legislation to that effect.  Florida House and Senate plans separate from the Negron Plan advocate premium assistance but do so:

  1. Solely with state funds; and
  2. Without fully expanding the insured population to 133% of the federal poverty level. 

On April 11, Florida House Speaker Will Weatherford (R) introduced “Florida Health Choices Plus,” which is also a premium assistance alternative to Medicaid expansion.  Only those earning up to 100 percent of the federal poverty level are eligible, i.e. $19,530 for a three-person family.  The plan includes $2,000 premium assistance subsidies.  With a deductible of $7,500, the family would need to spend one-third of its income before the premium assistance would kick in.  A plan similar to Florida Health Choices Plus exists in the Florida Senate and is being promoted by Senator Aaron Bean (R).  It remains to be seen how CMS will respond to such legislation.


Despite recent passage of the Arkansas bill promoting the premium assistance model (the Arkansas Model) in the Arkansas legislature, full details of the Arkansas Model have yet to emerge, and the Obama Administration has yet to formally approve the Model.  In fact, no premium support proposals have been submitted to CMS. 

Specific private insurance carriers have yet to be named, and it remains unclear if home health services will be covered.  Commercial insurers could either expand home access to home care or restrict care authorizations, as has occurred in the past. 

Another major concern is whether premium assistance models can be cost-effective and budget neutral.  While flexibility has been given to states to pursue premium assistance models, it remains to be seen how tolerant CMS will be of partial expansion plans if and when they become state law in opposition to federal guidelines. 

That said, 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, especially given its recent passage in the Arkansas legislature, 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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