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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

CMS Study Evaluates Utilization among Dual Eligibles

September 11, 2013 04:01 PM

In August, the Centers for Medicare & Medicaid (CMS) released a study titled Effect of Long-term Care Use on Medicare and Medicaid Expenditures for dual Eligible and Non-dual Eligible Elderly Beneficiaries.  Among other things, the study evaluated differences in case mix and expenditures of dual and non-dual beneficiaries in the community setting receiving Medicaid long-term care (LTC) and medical services, and compared institutional and community expenditures for LTC. 

Study Focus

While recognizing dual eligibles as “a heterogeneous group,” the study focused on utilization of services for older people enrolled in fee-for service (FFS) Medicaid and Medicare.  Specifically, the study sought to analyze the role of case-mix and long-term care setting in determining medical and LTC costs for dual eligibles.  Medicaid medical expenditures included ambulatory care, hospice care, inpatient care stays, labs/x-rays/rehabilitation, physical therapy/occupational therapy/speech-language pathology therapy, and primary care case management.  Medicaid LTC costs included home health services, intermediate care facility services, personal care services, state plan payments towards nursing facility services, targeted case management, and transportation.

Case Mix

The study compared the characteristics of duals versus non-duals across the seven states that were part of the study.  131,000 were duals using Medicaid LTC services in a community setting, while 7,100 were non-duals using Medicaid only services in a community setting.  The average Chronic Disease and Disability Payment System (CDPS) case mix score, while 3.95 for the Medicaid community group, was 6.33 for the duals community group.  The mean number of diseases was also higher among the duals community group, at 5.11 compared to 3.63 of the Medicaid Community group.  For complete characteristics of the various dual and non-dual groups, see Exhibit 1 on page E6-E7, here


Average total medical and LTC expenditures per beneficiary per year was significantly greater in the duals community group ($85,000) compared to the Medicaid community group ($19,500).  The bulk of total expenditures for the duals community group came from Medicare medical expenditures ($76,000), while the primary expenditure of the Medicaid community group was Medicaid LTC costs ($13,000).  The Medicaid community group had greater expenditures in both total Medicaid costs ($19,000 vs. $9,000) and total LTC costs ($13,000 vs. $8,400).  For the full data on expenditures, see Exhibit 2 on page E-8, here

Community LTC Costs Lower

The study further confirmed Council analysis that community costs for long term care are significantly lower than institutional LTC costs.  In the seven states analyzed in the survey, all seven (Arkansas, Florida, Minnesota, New Mexico, Texas, Vermont, Washington) had lower per beneficiary mean Medicaid expenditures (and mean Medicare expenditures) for community LTC recipients versus institutional LTC recipients.  Most states experienced at least half of the per beneficiary mean Medicaid expenditures for community LTC recipients than institutional LTC recipients.  For these statistics, see Exhibit 5 on page E-10, here.

The National Council on Medicaid Home Care’ Take

This study confirmed previous Council’s analysis that: 1) the duals population is more medically complex than the non-duals population; 2) duals account for greater overall expenditures than non-duals; and 3) community-based LTC is more economical than institution-based LTC.  Home care providers should note that this study had several limitations, as it 1) focuses on only a portion of the dual eligible population (the elderly); and 2) only addresses FFS beneficiaries and not the growing number of managed care dual eligible beneficiaries.  To see the Council’s briefs addressing dual eligibles, as well as managed care, click here.

Home care providers are encouraged to continue to advocate for reforms in the dual eligible demonstrations, to keep abreast of developments on CMS’ website, and the contact the Council with any questions or concerns.




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