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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

Report Discusses HCBS Utilization

May 22, 2014 09:50 AM

The Henry J. Kaiser Family Foundation recently released a report titled Medicaid Home and Community-Based Services Programs: 2010 Data Update (the Report).  The Report summarized utilization and spending data from three main sources of HCBS programs: the mandatory home health services state plan benefit; 2) the optional personal care services state plan benefit; and 3) the optional 1915(c) HCBS waivers. 

Not discussed in the Report were HCBS programs from the 1915(i) State Plan option, 1915(k) Community First Choice, Balancing Incentive Program, and Money Follows the Person. The Council discusses the Report’s key findings, providing approximate numbers in most instances.  The exact numbers can be found in the original Report, here.

Total HCBS Utilization

According to the Report, states spent a total of $52.7 billion in Medicaid HCBS expenditures in 2010, paying for services for 3.2 million people. Of the 3.2 million participants, approximately 44%, or 1.4 million, received services through 1915(c) waivers, 952,000 received services through state plan personal care services, and 26%, or 808,000, received services through state plan home health services.  Of the $52.7 billion in total Medicaid HCBS expenditures, 70%, or $36.8 billion, was spent on 1915(c) waiver services, 19%, or $10.2 billion, was spent on state plan personal care services, and 11%, or $5.7 billion, was spent on state plan home health services.

From 2000 to 2010, the number of total HCBS participants grew at an average of 4% each year, while total expenditures grew from between 6% to 14% each year.  For details, see Figures 4 and 7 of the Report, here.

Top states.  Out of the total 3.2 million HCBS participants in 2010, the states with the top five largest numbers of participants were: California (587,000), Texas (367,000), New York (280,000), North Carolina (117,000), and Ohio (111,000). For details, see Table 1A of the Report, here.  Of the total $52.7 billion in Medicaid HCBS expenditures, $9.7 billion was in New York, $6.5 billion was in California, $2.9 billion was in Texas, $2.7 billion was in Pennsylvania, and $2.3 billion was in Minnesota. For details, see Table 2A of the Report, here.

Medicaid 1915(c) Waivers

Out of the total 1.4 million people receiving services through 1915(c) waivers in 2010, approximately half (49%, or 681,000) were aged and disabled, while another 40%, or 567,000, were intellectually or developmentally disabled (I/DD) enrollees.  The latter group, however, was responsible for 71%, or $26.2 billion, in expenditures, while only 21%, or $7.8 billion of expenditures came from the aged and disabled population.  The remainder of expenditures and utilization was in a miscellaneous group composed of: the physically disabled, medically fragile/technology-dependent children, HIV/AIDS patients, those with mental health needs, and those suffering from traumatic brain and/or spinal cord injuries. For details, see Figure 10 of the Report, here.

Top states. Of the 1.4 million recipients of 1915(c) waiver services, the states with the top five largest numbers of recipients were: New York (101,000), California (100,000), Illinois (91,000), Texas (80,000), and Florida (77,000). For details, see Table 1D of the Report, here. Of the $36.8 billion in expenditures for 1915(c) waiver services, $5.7 billion was spent in New York, $2.5 billion was spent in Pennsylvania, $2.1 billion was spent in California, $1.9 billion was spent in Minnesota, and $1.8 billion was spent in Texas. For details, see Table 2D of the Report, here.

Self-direction. According to the Report, in 2012, 88% of states offering 1915(c) waivers had a self-direction requirement or option.  This amounted to 166 waiver programs in 42 states.

Waiting lists. Waiting lists continue to be a significant concern for states with 1915(c) waiver programs. According to the Report, 39 states had such waiting lists in 2012, which together totaled approximately 524,000 people.  Of this number, 304,000 on the waiting lists were people with I/DD, while 165,000 were aged and disabled.  According to most states surveyed, almost all of the people on waiting lists currently reside in the home and community, and not in an institution.  For a graph showing the growth of the 1915(c) waiver waiting lists from 2002 through 2012 by enrollment group, see Figure 12 of the Report, here.

Medicaid Home Health and Personal Care Services State Plan Benefits

Self-direction. According to the Report, in 2012, 20 states with personal care services state plan options had a self-direction option, while only seven states that had home health state plan services offered it.

Provider Reimbursement.  The Report also discussed provider reimbursements.  Home health visits were reimbursed to home health agencies at an average of $93.16 per visit in 2012, versus $89.73 in 2011.  States that paid registered nurses directly paid an average of $86.16 per visit in 2012, down from $94.06 in 2011. Those that paid home health aides directly paid them at $53.81, up from $50.84 in 2011.  For details on 2012 provider reimbursement, see page 13 and Table 12 of the Report, here.  For details on 2011 provider reimbursement, see Table 12, here. For a recent Council survey on Medicaid fee-for-service reimbursement rates, click here.


Waiting Lists. The National Council on Medicaid Home Care – a NAHC affiliate -  voices concern about the continued growth of the waitlists nationally. While most of those on waitlists reside in the home and community, they are not receiving the services they need and are thus at risk for institutionalization. This trend threatens to undermine states’ gains in rebalancing away from institutional care. Home care agencies should continue to lobby their states for the reduction and elimination of these wait lists.

Self-direction. Home care agencies should note that self-direction is most widely adopted 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.

Provider Reimbursement.  While the Council welcomes the positive developments of average reimbursement rates increasing for the most part in both home health services and personal care services from 2011 to 2012, it notes that the average registered nurse reimbursement did decrease among those surveyed. Further, in some states, the Report reflects a decrease in specific state reimbursement for home health agency (New Mexico, Texas, Washington State), registered nurse (Colorado, Michigan, Washington State), and home health aides (Idaho, Indiana, and Washington State) rates, in addition to personal care services agency rates (Montana) and personal care services provider rates (Maine) from 2011 to 2012.

While a small minority of states have faced such reimbursement rate cuts, home care agencies should nevertheless remain vigilant as states move to tighten their budgets and move into managed care. To assist in agencies’ advocacy efforts, the Council has compiled a comprehensive survey of Medicaid home care fee-for-service rates, found here.

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




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