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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

Legislation Would Modify Definition of “Full-Time Employee” from 30 to 40 Hours in the PPACA

April 26, 2013 01:03 PM

Senator Susan Collins (R-ME) recently introduced the “Forty Hours is Full Time Act of 2013” (S. 701).  It would modify the definition of full-time employee (FTE) for purposes of the shared responsibility mandates in the Patient Protection and Affordable Care Act (PPACA).  Starting in 2014, the PPACA imposes a $2,000 employer penalty for each full-time employee - after the first 30 - where the business employs 50 or more full time equivalent employees, does not offer health insurance to all employees, and at least one of the employees qualifies for a federal subsidy to purchase health insurance. The definition of “full-time employee” in the calculation of target employer’s penalty is based upon the total of the number of employees working at least 30 hours a week.  

S. 701 would change the definition of full-time employee to those working at least 40 hours a week rather than 30.  This would affect both the determination of whether the employer is a “large employer” subject to the mandate and the number of employees for whom the employer would have to provide health insurance or pay a penalty.  These changes would be beneficial to home care agencies that are unable to provide health insurance and are thus subject to the penalties. The legislation would also result in a definition of “full-time” that is more in line with current employment practices related to qualifying for health insurance. If passed, S. 701 would provide more leeway for home care employers who may be considering restricted working hours of employees in order to avoid or reduce the penalty that they currently face.

In its Legislative Blueprint for Action, NAHC asserts that home care businesses with more than 50 FTEs have three problems that are fairly unique for employers impacted by PPACA.  First, home care is most often paid for by government programs such as Medicaid and Medicare. These programs do not normally raise payment rates adequately - or at all - to cover increased costs.

Second, the consumer of private pay home care is most often an elderly or disabled individual on a fixed or low income who cannot afford to absorb any additional price increases that would be needed to cover the  cost  of  employee  health  insurance  or  the  alternative penalty.

Third, the home care workforce is often employed with widely varying weekly work hours because of the constantly changing home care clientele and the always changing needs of those who require home care services. The model defining FTE in the current law does not accommodate these variations.

The Paraprofessional Healthcare Institute (January 2006) found that 40 percent of home care workers lack health insurance coverage, compared to the Bureau of Labor Statistics estimate of 16 percent for all workers. The estimate for home care workers does not include privately paid workers and those who work part time, so the overall percentage of home care workers without health insurance is likely well over 50 percent. A 2013 survey by the National Association for Home Care & Hospice indicates that 35 percent of Medicare home health agencies do not offer health insurance to their employees while 65 percent of Medicaid home care companies and private pay home care companies do not offer health insurance.

The absence of health insurance for home care workers will lead to significant monetary assessments against home care companies. Current reimbursement levels in Medicare and Medicaid - along with the barriers to price increases in private pay home care - put continued access to care in severe jeopardy. The only business option available to home care companies in these circumstances is to limit the working hours of caregiving staff to less than 30 hours per week (40 if S. 701 were enacted). This will likely lead to increased turnover, lower overall wages, and the weakening of the quality of care – all while still being unable to provide health insurance for the home health workforce.

NAHC has called on Congress to exempt home care providers from the PPACA employer responsibilities, provide a subsidy to all home care providers to supply health insurance, and/or provide a subsidy or tax credits to home care clients to cover the increased cost of care triggered by the employer responsibility provisions.  Congress should help the states ensure that low-wage home care workers have health insurance through Medicaid or otherwise.

Congress should amend PPACA to require that all government health programs adjust provider rates to meet the additional costs that will be incurred by health care providers to make health insurance available to all their employees.  In addition to expanding the definition of full time to 40 hours a week as called for by S. 701, Congress should also amend PPACA to allow for a definition of a full-time employee that evaluates the individual’s working hours over a 180-day period rather than the current monthly calculation.




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