National Council on Medicaid Home Care Analyzes Medicaid Provisions in President’s 2015 Budget
March 7, 2014 02:59 PM
On March 4, President Obama released his budget proposal for the Department of Health and Human Services (HHS) for Fiscal Year 2015. The National Council on Medicaid Home Care – a NAHC affiliate - reports on the budget’s implications for Medicaid home care.
Overall Medicaid budget. Overall, outlays in Medicaid were expected to rise from $2.7 billion in 2013 to $3.1 billion in 2014 to $3.4 billion in 2015. The budget also includes a total of $7.3 billion in total savings to the Medicaid program. For details, see pages 14 and 55, here.
Program integrity. Under the President’s budget proposal, FY 2015 Medicaid program integrity expenditures will total $522 million, of which $423 million is the federal share. To see the breakdown of these costs, see page 72, here. To see total investments and savings in the Medicaid Integrity Program from 2014 through 2024, see page 70, here. Program integrity legislative proposals would altogether amount to $620 savings over 10 years. See page 81, here.
MFCU mandate extended into home based care. The budget proposal gives Medicaid Fraud Control Units (MFCUs) the option to get federal matching funds to investigate and prosecute home care abuse and neglect. This provision thus increases the prosecutorial power of the MFCUs into home care, as it had traditionally been more institution-focused. This provision is estimated to have no budgetary impact. For details, see page 73, here.
Medicaid Legislative Proposals
The President’s 2015 budget also highlights several Medicaid legislative proposals, including:
Provide HCBS to children eligible for psychiatric residential treatment facilities. This proposal allows states to expand to non-institutional options for children’s mental health care. This would encourage rebalancing of this population that is currently institutionalized or otherwise meet the institutional level of care. Otherwise, this population would only be able to receive care in an institution. This provision is inspired by the Community Alternatives to Psychiatric Residential Treatment Facilities Demonstration Grant Program that saw savings of approximately $40,000 per year per participant. This provision is estimated to cost $1.9 billion over 10 years. For details, see page 80, here.
Dual eligible provisions. These proposals include integrating the appeals process for duals (no budgetary impact), and a pilot to expand the Program of All-Inclusive Care for the Elderly (PACE) to those aged 21 through 55 (no budgetary impact). PACE is a rebalancing program that provides community based LTSS to duals via an interdisciplinary team. For details, see pages 81-82, here.
Expand Money Follows the Person. This proposal would extend this rebalancing demonstration program through FY 2020. Currently, eligibility for Money Follows the Person (MFP) is based on institutionalization. This proposal would allow these funds to prevent people from being institutionalized at all in some instances, reduce the existing institutional requirement to 60 days (from 90 days), and also allow skilled nursing facility stays to count toward this requirement. The proposal would also allow for transitions to HCBS to those in certain mental health facilities. For details, see page 91, here.
Administration for Community Living
The budget proposal allocates $1.2 billion to the Administration for Community Living to assist seniors in independent and community living. This includes $815 million in nutrition services. In addition to the $1.2 billion, the budget proposal also includes $348 million for home and community based services for seniors. For details, see page 121, here.
The Council supports continued efforts at rebalancing, as evidenced in this budget proposal, including proposals to expand PACE, MFP, and to provide HCBS to children eligible for psychiatric residential treatment facilities. The Council also supports reasonable program integrity measures, and advises home care companies to strengthen their compliance efforts in light of this budget proposal’s financial incentives for MFCU investigations and prosecutions into home care.
Stakeholders should actively engage in the process of regulatory and legislative reform through the forums for state advocacy. Home care companies are encouraged to keep abreast of developments, and to contact the Council with any questions or concerns.
For more analysis on the President’s Budget from NAHC, please see NAHC Report, March 5, 2014 and NAHC Report March 7, 2014.