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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 Analyzes April Report on Money Follows the Person Utilization

May 16, 2014 03:30 PM

On April 25, the Henry J. Kaiser Family Foundation released a report titled Money Follows the Person: A 2013 State Survey of Transitions (the Report). The National Council on Medicaid Home Care – a NAHC affiliate - discusses the Report’s key findings, providing approximate numbers in most instances. 

The exact numbers can be found in the original Report, here.

Overview of MFP

The Money Follows the Person Demonstration Grant (MFP) provides states with grant money for rebalancing Medicaid long-term services and supports (LTSS) for the chronically ill and disabled from institutional care to home and community-based care. Such grant money is provided for 12 months per each enrolled Medicaid beneficiary. States provide a flexible budget that the Medicaid beneficiary uses to purchase a variety of services and items to stay in the community.

MFP was authorized by Congress in 2005, and in 2010, expanded through 2016 under the Affordable Care Act. An analogous program, called the Money Follows The Person Tribal Initiative, exits for Native American communities. For a link to CMS’ description of MFP, click here.

Overall Utilization

According to the Report, in 2013, MFP had expanded to 40 states and 35,400 cumulative “transitions,” i.e. transitions from an institution to the home and community through the MFP program. This is up from 37 states and 25,100 cumulative transitions in 2012 and 31 states and 16,600 cumulative transitions in 2011.

For details, see Figure 3 of the Report, here.

Out of the 35,400 cumulatively transitioned in 2013, 13,500 were individuals with physical disabilities, 13,300 were seniors, 6,800 were individuals with intellectual/developmental disabilities, and 1,800 were individuals with mental illness. Ohio, Texas, and Washington State account for 40 percent of those cumulatively transitioned in 2013. Nationally, there are approximately 5,800 transitions in progress.

For details, see Figure 2 of the Report, here.  

As of August 2013, 42 states, including Washington, DC, currently have MFP, while 6 states do not. The remaining three states either have an inactive demonstration (Oregon), or are either a new grantee or are not yet operational (Montana, South Dakota).

For the full map, see Figure 1 of the Report, here.

Services Offered

Forty-three states offered HCBS to MFP enrollees through HCBS waiver programs, while 34 states do so under their state plans. Such HCBS included: adult day health care, case management, habilitation, home health aide services, homemaker services, personal are services, and respite services.  Additionally, eighteen states offered supplemental services including: assistive technology, employment training, home-delivered meals, ombudsman services, one-time housing expenses, and transition coordination.


Most states reported that their MFP programs have self-direction options, but also report low participation rates in that regard.  The Report estimated that only approximately 19 percent of MFP participants chose to self-direct services in 2013. For details on self-direction, see page 11 of the Report, here.


According to the Report, the average age of all MFP enrollees was 58 years old, while MFP enrollees with an intellectual/developmental disability ( I/DD) averaging 46 years of age, those with mental illness averaging 49 years of age, and those with a physical disability averaging 51 years of age. Thirty-eight percent of MFP participants were physically disabled, while 37.5% were seniors, and 19% had an I/DD.

Rebalancing and “re-institutionalization”

It took MFP enrollees an average of 3.5 months to transition to a home or community setting. MFP participants were “reinstitutionalized,” i.e. returned to a hospital, intermediate care facility for individuals with I/DD, or a nursing facility, at a rate of 11 percent in 2013. This rate was slightly higher than the 8 percent reported in both 2011 and 2012.


Per-capita expenditures. The average per capita monthly expenditure for all MFP participants in 2013 was $3,900, a decrease from $4,400 in 2012. The average per capita monthly expenditure in 2013 was $7,500 for I/DD participants, $2,900 for the physically disabled, $2,600 for those with mental illness, and $2,200 for seniors.

Cost containment. Only five states noted that there were or will be cuts to their MFP programs due to fiscal concerns.

Other LTSS Priorities. Forty states with MFP are implementing or will implement at least one more Medicaid rebalancing program, such as a Section 1915(i) State Plan Option, a health home, the Balancing Incentive Program, and/or the Section 1915(k) Community First Choice state plan option. Twenty-four states have MFP participants in their managed LTSS programs.  


Self-direction. Home care agencies should note that self-direction is not as widespread in MFP as it is in HCBS waivers. The Council supports self-directed models of care that are compliments of, and not replacements for, agency models of care. The Council also supports these self-directed models as long as beneficiaries are afforded the same level of care and protections as those in an agency-model of care.

For details, see pages 14 and 15 of our 2014 policy blueprint, here.

Cost containment. The Report noted that per-capita MFP expenditures decreased in 2013 from 2012 levels, and that only five states expressed concerns that MFP would cause significant fiscal concerns. This reaffirms the Council’s position that MFP, and rebalancing programs generally, are cost-effective.

Home care agencies are advised to continue to monitor Money Follows the Person in their states, and contact the Council with any questions or concerns.







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