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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

Federal Commission on Long-Term Care Holds its Inaugural Hearing

July 10, 2013 03:19 PM

On June 27, Steve Postal, director of the Medicaid Resource Center for the National Council on Medicaid Home Care (the Council), a NAHC affiliate, attended the Federal Commission on Long-Term Care’s inaugural hearing entitled: “The Current System for Providing Long-Term Services and Supports (LTSS).”  The following members of the Commission were in attendance:

Chris Jacobs, George Vradenburg, Stephen Guillard, Carol Rafael, Lawrence Atkins (Staff Director), Bruce Chernof (Chair), Mark Warshawsky (Co-Chair), Henry Claypool, Neil Pruitt, Judith (Judy) Feder, Javaid Anwar, Grace-Marie Turner, and Judith (Judy) Brachman.

For brief bios on the members of the Commission, please click here and here.

The hearing gave the Medicaid Council, as well as other interested parties, a synopsis of current and projected trends in LTSS, reaffirming The Council’s belief that it will continue to migrate towards home and community-based services (HCBS), and that Medicaid will be its primary payor.

The hearing featured four witnesses:

  • Anne Timlinson, Senior Vice President, Avalere Health
  • Kirsten Colello, Specialist in Health and Aging Policy, Congressional Research Service
  • G. William Hoagland, Senior Vice President, Bipartisan Policy Center
  • Marc Cohen, Chief Research and Development Officer, LifePlans, Inc.

Bruce Chernof, the chair of the Commission, called the meeting to order.  He gave introductory remarks, stating that this was the initial meeting of the Commission, which was three days old.  Mr. Chernof mentioned that the purpose of the Commission was to learn about the current long term care (LTC) system, and to think about how to restructure the LTC system, given the aging population and fiscal considerations.  He also stated that the Commission has a very short timeline - i.e. 6 months from when its members were appointed - to complete their objective. 

The Commission will send its recommendations to Congress by the end of September.

Anne Timlinson’s presentation was entitled “The Diversity of the Long Term Care Population: Understanding the Need.” She discussed that the LTC population is quite diverse, but had a common need in substantial assistance with activities of daily living (ADL). She stated that the need varies if comparing different age groups, precipitating events/conditions, and places of residence. 

In 2007, there were 11.1 million people with LTC needs. Of those, 9.6 million lived in the community, while 1.5 million lived in nursing homes. Of those living in the community, 4.7 million were under 65, while 4.9 million were 65 or older. 

Those needing LTC aged 65 or older tend to be very old, female, have low incomes, and have lots of needs. Those needing LTC aged under 65 tend not to be defined so much by gender, and if anything, they would tend to be male.  The latter group also tends to be unmarried and have low incomes.  Also, the 65 or older LTC group tends to have cognitive impairments, while those under 65 tend to have developmental disabilities. 

Anne also mentioned that the size of the LTC population is expected to rise by 70%. There were 9.8 million LTC users in 2010, and the population is projected to be 10.5 million in 2020, 12.1 million in 2030, 14.6 million in 2040, and 16.5 million by 2050.

Kirsten Colello discussed the financing of LTSS in her presentation entitled: “Long Term Services and Supports.”  The LTSS expenditure breakdown in 2011, by payor, was $133.5 billion (42%) Medicaid, $73.5 billion (23.8%) Medicare, and $22.1 billion (7.0%) other public sources. The total public expense was $230.9 billion (72.8%) in 2011. Also in 2011, total home care expenditures came to $104.8 billion, with $67.6 coming from Medicaid, $35.0 coming from Medicare, and $2.3 coming from other public sources. 

Ms. Colello also stated that the proportion of Medicaid LTSS by setting has shifted dramatically from the institution to home and community based services (HCBS); in 1995, only 20.8% was HCBS, but by 2011, it was 50.6%. Kristen also discussed the HCBS programs available to states, including state plans (1915(i)) and waivers such as the 1915(c), 1915(j) and 1115 waivers.

G. William Hoagland’s presentation was entitled: “The Federal Budget Environment for Long Term Health Care.”  He discussed the current fiscal outlook, near term restraints on costs, and rough estimates of long term care costs in the future. He presented slides on the total budget surplus/deficit for FY 1965-2022, and the budget outlook for FY 2012 to 2018, emphasizing the accumulation of debt held by the public is projected to be over 70% of GDP for FY 2012 to 2018. 

Mr. Hoagland projects that in 2023, federal spending for Medicaid will be 10 percent of the total budget. Mr. Hoagland also presented that Medicare and Medicaid as a source of funds for long-term health expenditures have increased from 25% of these expenditures in 1970 to 68% in 2020.  He concluded two things:

1) Medicare and Medicaid are a major force in health care, but they cannot be expected to be consumed at a sustained pace; and

2) once these programs become available, Medicare and Medicaid pay for the most expensive long term care.

Marc Cohen’s presentation was entitled “The Current State of the Private Long Term Care Insurance Industry.”  He stated that the individual and group markets for private long-term care insurance (LTCI) totals 7 million people who pay about $10 billion in premiums. However, the number of insured has remained flat since around 2005.  While traditionally just coverage for nursing home care, LTCI now provides coverage for a wide variety of services, including nursing home, assisted living, and home care services. 

Of the people surveyed in 2010 as to why they don’t buy LTCI, 61% said because it was too costly.  Mr. Cohen also mentioned that there are partnership programs in 45 states, where purchasers of LTCI can access Medicaid without spending down their assets.

The individual testimonies were followed by a question and answer session. Most of the questions concerned private insurance and were directed to Mr. Cohen.

Ms. Feder asked Ms. Collelo about if she can clarify the variation of practices across states regarding Medicaid coverage. Ms. Collelo replied that in addition to some states being required to offer HCBS in their state plans, most HCBS are optional, through waivers. She stated that there are over 300 1915(c) HCBS waiver programs in the nation, and that some states are using 7-8 waivers.  In this way, they are able to target specific populations while controlling costs by limiting eligibility criteria, geographic application, and enrollment generally.    


The witnesses’ presentations and discussions confirmed Council analysis that LTSS continues to shift away from the institutional setting and towards HCBS. Medicaid continues to be the largest payor of LTSS, especially as states continue to leverage their state plans and HCBS waivers to provide customized LTSS to specific populations at less cost.

The shifts in LTSS financing will give home care providers rebalancing opportunities, as a stronger emphasis is placed on community based systems over institutional settings.  Home care providers should continue to keep abreast of the state plan and HCBS waivers in their state, and to contact the Council with any questions or concerns.  




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