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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

Medicaid Council Advocates for Employer Mandate Fix

March 14, 2014 09:42 AM

The employer mandate under the Affordable Care Act is expected to have a significant negative impact on home care providers beginning in 2015. A 2013 study conducted by the National Association for Home Care & Hospice found that nearly 75% of Medicaid-oriented home care agencies do not provide health insurance to their personal care attendants/home care aides. For private pay companies, the number rises to 90%.

Since 2011, NAHC has advocated for reforms that would eliminate or mitigate the impact of the employer mandate on home care. Potential remedies include an exemption of home care employers, a modification of the definition of "full-time employee," and additional funding to pay for the cost of health insurance or the employer penalty.

Recently, the National Council on Medicaid Home Care, a NAHC affiliate, met with officials from the Centers for Medicare and Medicaid Services and the Internal Revenue Service to attempt to craft a Medicaid-specific remedy. The fact that Medicaid is partially funded by federal monies provides some opportunity for unique remedies that would not fit for private pay home care.

The Medicaid Council was joined by a number of other stakeholder organizations at the meeting - including representatives from independent living centers, developmental disabilities community care providers, and direct care home care companies. It became quickly apparent that CMS understands that there is a significant problem facing the future of home care and other direct care providers in Medicaid.

Bill Dombi, Executive Director of the Medicaid Council, explained that, "the largest "employer' of low wage workers without health insurance is Medicaid," as payment rates set by state Medicaid programs severely limit a home care provider's ability to set worker wages and benefits.

Cindy Mann, director of the Center for Medicaid at CMS, expressed that CMS has previously informed states that the federal share of Medicaid costs is available to states that raise payment rates to cover ACA employer mandate costs. However, she further indicated that CMS will not order states to increase their rates.

In response, the collaborative of stakeholders explained that it is recognized that CMS has limited control over state decisions, and that there are a variety of other remedies that may be available.  Further, it was explained that some states may wish to use different remedies than others. 

Alternative remedies suggested during the meeting include an automatic enrollment of full-time workers in Medicaid, a pass-through payment for commercial insurance enrollment, reductions in administrative requirements to reduce provider costs, and exemption of Medicaid employers. These remedies were presented as examples of options, and not as a full and comprehensive list of choices.

To achieve the best state-specific result, the group recommended that CMS convene a stakeholder summit where all possible remedies could be discussed and evaluated. CMS would then convey the range of options that states could consider and apply those that best fit their unique needs. It was further recommended that CMS encourage states to submit the equivalent of an ACA Employer Mandate Compliance Plan that would detail the steps states are taken to ensure continued care access.

As it is highly likely that the recommended summit and CMS guidance would take time to develop and implement, it was also recommended that the IRS establish further transitional relief - delaying the employer mandate for Medicaid-focused companies to provide states with the opportunity to put the chosen remedies in place. 

Since the CMS meeting, other stakeholders have come forward expressing support for the recommendations advanced by the Council and the collaborative. No decision on the recommendations has been made at this point. In the meantime, the Council is pursuing bipartisan congressional support for the reforms.

The ACA employer mandate issue promise to take on a higher profile as the fall elections approach, along with looming 2015 compliance date. NAHC and the Council will continue both the broad-based advocacy efforts to bring about a remedy for home care at large - as well as on more focused efforts, such as Medicaid, where unique remedies may be available.

The upcoming March on Washington presents a great opportunity to meet with your congressional representatives on this issue. In addition, a special program on the ACA employer mandate is scheduled for March 24. For more information about the March on Washington, please click here.




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