The National Council on Medicaid Home Care Hosts Teleconference on the Companionship Exemption
October 10, 2013 01:39 PM
The National Council on Medicaid Home Care – a NAHC affiliate – recently hosted a teleconference to discuss recent developments surrounding the Companionship Exemption. Bill Dombi, the Council’s Executive Director and NAHC’s Vice President for Law, led the call and made the following Medicaid-specific points for those who participated:
The redefinition of “companionship services” by the Department of Labor rule should automatically exclude all Medicaid-covered services from what remains of the exemption. The new definition limits “personal care” to no more than 20 percent of the work done. Medicaid home care benefits do not cover “fellowship and protection” which is what “companionship services” is limited to.
The change in companionship services definition means that state Medicaid programs will face a new cost that they are not likely capable of meeting, at least easily. Unless Medicaid raises its payment rates, providers may have no choice but to avoid overtime work hours through the use of part-time workers or to reduce the hourly wage for workers to have funds to cover any overtime costs.
The rule change equally affects agency-model personal care under Medicaid and consumer-directed care. In doing so, at least the rule change does not give consumer-directed care delivery models a financial advantage.
Medicaid live-in services are significantly impacted. Medicaid providers of live-in care must pay for all hours worked by live-in staff with at least minimum wage plus overtime compensation. States can avoid this cost through a delivery model that has the consumer as the sole employer.
Medicaid home care programs that are run through a “public authority” model are highly likely to be considered as a government joint employer with the consumer. As a joint employer, the program would have a minimum wage and overtime obligation while the consumer may not.
For more information on the Council, its policy positions and additional resources, please click here.