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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

Republican Legislative Proposal Aims to Adopt Per Capita Cap for Medicaid

May 16, 2013 04:15 PM

On May 7, Representative Bill Cassidy, M.D. (R-LA) introduced the Medicaid Accountability and Care Act of 2013  (the MAC Act) - H.R. 1853.  The bill calls for a modernization of Medicaid financing through controlled spending, an emphasis on value-based incentives, and fighting fraud. 

Dr. Cassidy’s bill largely mirrors a Republican proposal to reform Medicaid entitled “Making Medicaid Work: Protect the Vulnerable, Offer Individualized Care, and Reduce Costs” (the Proposal).  This Proposal was released on May 1, and co-authored by Representative Fred Upton (R-MI), Chairman of the House Energy and Commerce Committee, and Senator Orrin Hatch (R-UT), Ranking Member of the Senate Finance Committee.  The stated goals of the Proposal are to “modernize the Medicaid program” by “equipping states to implement patient-centered reforms” and “imposing fiscal discipline in the program.”

Per Capita Cap

The key element of the Proposal is a per capita cap.  Essentially, Congress would place per capita caps on the four major Medicaid beneficiary groups: aged, blind and disabled, children, and adults. 

The total Medicaid allotment under this plan would be calculated by taking the number of enrollees in each of the groups, and multiplying them by the per capita amount for each of the groups, then adding these products together. 

The per capita amount for each group would be based on state-specific-expenditure data.  For a complete methodology of how the per capita amount is calculated, see page 14 here.

Some payments would be exempt from a per capita cap, and instead would be disbursed through separate funding streams.  One such group includes payments to states for dual-eligibles, if their Medicaid expenses are limited to premiums and cost-sharing.

Existing Benefits for Disabled Maintained

The Proposal safeguards preserving benefits for the disabled, providing “a guaranteed protection of current law benefits” for this group.

Risk Corridors for Disabled Per Capita Amounts

That said, states that achieve greater efficiencies in using their Medicaid funds would be able to take advantage of a shared-savings and risk corridor model.  This would also influence the state to avoid “unpredictable spending” on vulnerable populations like the disabled.

Premium Assistance

The Proposal would promote states offering premium assistance, so that beneficiaries could receive coverage similar to private insurance.


The Proposal would allow cost-sharing with less restrictions as it exists under current law, in order to promote greater value and combat over-utilization.  States would be given significant latitude in developing enforcement mechanisms.

Alignment of Provider Incentives

Additionally, value-based payment models would align provider incentives, thereby increasing cooperation among specialties and settings.  Namely, these providers include “hospitals, post-acute care providers, physicians, and other practitioners.”

Streamlining Section 1115 Waiver Process

Waiver Clock: The Proposal would streamline the Section 1115 waiver application process in order to promote greater efficiencies and innovative ideas from the states.  Namely, the Proposal would establish strict deadlines for the federal government to respond to waiver requests: 60 days from application to send the state a final round of questions, and a final answer within 120 days of application.  States would have the option to give the federal government 30-day incremental extensions in the event of “productive discussions.” 

Waiver Reciprocity: Additionally, the Department of Health & Human Services (HHS) would be required to approve waivers that have been previously approved in other states, so long as the waivers met cost containment requirements. 

Waiver Integrity Improvements: The CMS Office of the Actuary would be required to review and approve the budget neutrality component of the waiver applications.

Moderate Support for Existing Dual Eligible Efforts

This Proposal also supports the existing efforts to coordinate care for the dual eligibles.  Specifically, payments for dual eligibles whose expenses are only cost-sharing and premiums will be exempt from a per capita cap.  This is a small group compared to dual eligibles generally.


While the Proposal would transform Medicaid payment, many unknowns remain for home health providers.  While the Proposal favors the alignment of provider incentives, home health providers are not explicitly mentioned as targeted providers.  Home health services are also not specifically mentioned as services that would have a per capita cap. 

While the Proposal explicitly guarantees that benefits for the disabled will not be cut, providers should be aware that the shared savings and risk corridor model will put increased pressure on them to enhance quality of care to the disabled population, as well as to reduce over-utilization.  Stakeholders should be also aware of Congress’ bi-partisan effort to place greater emphasis on quality of care, and providers should redouble their efforts in this regard.  

Other stakeholders, including the White House, disability and senior citizen advocacy groups, have expressed additional concerns.  These groups have questioned if a per capita cap would shift cost burdens to the states, and limit federal contributions without achieving great positives. 

Potential opportunities exist for home health providers with regard to premium assistance and waivers.  Although it remains to be seen if home health services will be covered in the promoted premium assistance, premium assistance may translate to increased reimbursement that surpasses 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 can also look forward to more reimbursement options as the Section 1115 Waiver process is streamlined. 

NAHC is continuing to study the implications of a per capita cap on Medicaid and will continue to monitor the Proposal.  Home health providers are encouraged to keep abreast of federal and state efforts to reform Medicaid, and to contact NAHC with any questions or concerns.  NAHC urges home care and hospice advocates to ask their Members of Congress to protect access to home care and hospice for low income Medicaid beneficiaries by opposing proposals that would reduce federal Medicaid funding. 

For a link to NAHC’s Legislative Action Network (LAN), as well as a link to NAHC’s Medicaid issue brief and talking points on NAHC’s LAN page, click here.

For a link to the MAC ACT, as well as a FAQ and overview, click here.

For a link to Making Medicaid Work, click here.




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