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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

National Council on Medicaid Home Care Reports on Personal Care Services Utilization Trends

January 13, 2014 03:36 PM

In response to member inquiries, the National Council on Medicaid Home Care – a NAHC affiliate - researched state adoption and utilization trends of personal care services (PCS) as a Medicaid benefit.  While defined differently by state, PCS usually refer to activities of daily living (ADLs) assisted by a personal care attendant such as bathing, dressing, eating and drinking, grooming, mobility, toileting, and transferring.  Personal care attendants usually assist beneficiaries in performing these ADLs under PCS.

PCS is defined in the Federal Register (42 CFR 440.167) as follows:

440.167 Personal care services.

Unless defined differently by a State agency for purposes of a waiver granted under part 441, subpart G of this chapter–

  • Personal care services means services furnished to an individual who is not an inpatient or resident of a hospital, nursing facility, intermediate care facility for individuals with intellectual disabilities, or institution for mental disease that are–
    • Authorized for the individual by a physician in accordance with a plan of treatment or (at the option of the State) otherwise authorized for the individual in accordance with a service plan approved by the State;
    • Provided by an individual who is qualified to provide such services and who is not a member of the individual’s family; and
    • Furnished in a home, and at the State's option, in another location.
  • For purposes of this section, family member means a legally responsible relative.

PCS is an optional benefit that, if chosen by a state, must be provided to all eligible populations in a comparable scope and manner.  With optional benefits, states cannot discriminate within the Medicaid population.  Also, states adopting PCS cannot limit the number of participants as they can with HCBS waiver programs.

The Council reports on key findings of PCS programs as derived from Kaiser data.  Kaiser’s data focuses purely on PCS programs.  Other data, such as expenditure and enrollment data from Table 18 of the most recent (FY 2009) Center’s for Medicare and Medicaid Services’ (CMS’) Medicaid Statistical Information System (MSIS) Tables, have spending and utilization data on Personal Support Services (PSS) more broadly. 

PSS includes many services including the specific Medicaid benefit of Personal Care Services (PCS).  PSS also includes: targeted case management services, therapy, hospice services, private duty nursing, and others.  CMS does not provide expenditure and enrollment data for PCS or the other specific elements of PSS.  According to CMS, PSS totaled $25.6 billion in 2009, whereas according to Kaiser, as shown below, PCS totaled $11.1 billion that same year.

For a link to CMS’ definitions of PSS and PCS of terms, see pages 159-160, here.

Sli​ghtly More States Offer PCS Than Do Not.  As of 2010, 29 States, including DC, offer PCS as a Medicaid benefit, while 25 states, including American Samoa, Guam, Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands do not. 

Common Restrictions and Payment Methods.  Nineteen of the 29 states that offer PCS as a benefit require prior approval.  Most states put some restriction on the benefit, including the duration that is reimbursed.  Other states, such as Missouri, New York, and Utah, require RN supervision for the services.  27 of the 29 states reimburse PCS via fee-for-service (FFS), with at least nine of these states reimbursing in hourly increments.  

Beneficiaries.  As of 2009, there were 912,000 PCS beneficiaries, up from 528,000 in 1999, an increase of 42.1%.  The states with the five most PCS beneficiaries in 2009 were: California (425,000), New York (75,000), Michigan (59,000), North Carolina (53,000), and Missouri (53,000).  Therefore, approximately 46.6% of PCS beneficiaries were in California, 8.2% were in New York, 6.5% were in Michigan, 5.8% were in North Carolina, and 5.8% were in Missouri. 72.9% of all PCS beneficiaries in 2009 resided in these top five states.

Expenditures.  As of 2009, PCS expenditures totaled $11.1 billion, up from $4.1 billion in 1999, an increase of 62.8%.  The states with the five greatest PCS expenditures in 2009 were: California ($4.9 billion), New York ($2.2 billion), Texas ($480 million), Minnesota ($396 million), and Massachusetts ($356 million).  Therefore, approximately 44.4% of PCS expenditures were in California, 20.2% were in New York, 4.4% were in Texas, 3.6% were in Minnesota, and 3.2% were in Massachusetts.  75.8% of the total PCS expenditures in 2009 came from these top five states.

For links to Kaiser’s statistics on PCS, click herehere, and here.

The Council sees PCS as a key vehicle in facilitating the push to re-balance long term services and supports expenditures away from the institution and towards the home and community.  The Council supports universal standards for PCS, and for PCS to be covered as a Medicaid benefit in all states.  For details, see pages 15 and 25 of our Policy Blueprint, here.  




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