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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

CBO Report Suggests Federal Caps to Medicaid

December 4, 2013 09:12 AM

Earlier this month, the Congressional Budget Office (CBO) released a report entitled Options for Reducing the Deficit, 2014 to 2023 (the Report).  Among various other options, CBO analyzed what effect a federal cap to Medicaid would have on the federal budget, proposing this as an option to reduce the deficit.

Report Implicitly Targets Long Term Care: In its analysis, CBO broke down the main drivers of Medicaid spending.  At $71 billion, CBO listed long term care as the second largest expenditure in 2012 after acute care (at $152 billion).  While CBO suggested that a carve-out for caps on the elderly and disabled was possible, doing so “would save far less” given that this group currently is responsible for 65 % of Medicaid spending.  For details, see page 188-189, here.

Both General and Per-Enrollee Cap Would Generate Savings: To calculate savings, CBO used 2013 spending data as the “base rate” and modeled the spending caps to be effective in October 2015.  CBO projected that an overall federal spending cap on Medicaid would generate $450 billion in savings from 2014 to 2023 via a cap based on the CPI-U growth factor, and $105 million via a cap based on the NHE growth factor.  CPI-U stands for the Consumer Price Index for all Urban Consumers, reflecting a general rate of inflation, while NHE stands for National Health Expenditures, and reflects per capita growth in national health expenditures consistent with an increase in per capita GDP.  Percentage points were added to the growth factors of the overall federal spending cap to reflect increased enrollment due to the ACA expansion.

A per-enrollee spending cap (alternatively known as a “per-capita cap”) would bring $606 billion in savings during the same time frame via a cap based on the CPI-U growth factor, and $282 million via a cap based on the NHE growth factor. 

For full explanations of the growth factors and their augmentation, see page 189 and 191-192, here.  For a chart modeling the various cap scenarios, see page 186, here.

CBO stated that normally, a general cap should generate more savings.  However, given, among other things, CBO’s present projections of a decline in Medicaid enrollment in the non-expansion population due to a forecasted recovery in the economy, CBO estimated that there would be more savings through a per-enrollee cap.  For details, see page 192, here.

Flexibility for States May Generate Federal Savings: CBO recognized that generally, increasing flexibility for states to structure their Medicaid programs can either increase or decrease the federal budget.  However, increasing state flexibility would generate federal savings in Medicaid if: ”states had enough flexibility to scale back their programs to the point where federal spending was less than the caps; federal funding remained linked to the level of state funding, as under current law; and some states chose to do such scaling back.” See page 190, here.

For the Report’s full analysis of Medicaid caps, see pages 186-194, here.


The National Council on Medicaid Home Care – a NAHC affiliate - opposes caps on federal Medicaid payments. Specifically, the Council calls on Congress to abandon proposals for such caps, and instead increase the federal Medicaid match (FMAP) so that states can focus more on providing home and community-based services (HCBS).  For details of this policy position, see pages 18-19 of the Council’s Legislative Blueprint, here

The Council also continues to advocate for preserving Medicaid payments to home care providers by supporting the establishment of Medicaid home care as a mandatory benefit and appropriate Medicaid rates for home care and hospice.  For details, see pages 16-17, and 20-21 of the Council’s Legislative Blueprint, here

The Council strongly supports re-balancing long-term care expenditures towards HCBS without caps.  To this end, the federal government and states should embrace federal programs such as Community First Choice (CFC), Balancing Incentives Payment Program (BIPP), and 1915(i) State Plan options and less on waivers, as the latter allows for state caps on HCBS.  While states may be hesitant to place less emphasis on waivers, the Council believes that further leveraging the federal programs instead would bring HCBS to a greater number of enrollees.  This would increase the chances of enhanced rebalancing, which would reduce costs to states by avoiding more costly institutionalizations.

Home care providers are encouraged to keep abreast of Medicaid funding and HCBS developments in their states, and nationally, and to contact the Council with any questions or concerns.




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