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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

NAHC Affiliate, National Council on Medicaid Home Care, Holds Call with the Experts on Balancing Incentive Program

May 30, 2014 09:46 AM

The National Council on Medicaid Home Care - a NAHC affiliate - recently held its monthly “Call with the Experts” teleconference. The call was an open discussion among Council members on the Balancing Incentive Programs (BIP). Michelle Martin, the Council’s director of policy, moderated the call. The main contributors on the call were:

  • Beth Foster, Director of Regulatory Affairs, Ohio Council for Home Care & Hospice;
  • Vicki M. Hoak, CEO, Pennsylvania Homecare Association; and
  • Jenny Sand, Chief Strategy Officer, Home Care by Black Stone.

The call discussed the background of BIP, how BIP is being implemented in the states, and BIP’s efficacy in rebalancing LTSS away from institutions and towards the home and community.


At the beginning of the call, Ms. Martin gave a brief overview of BIP. BIP, a program arising out of the Affordable Care Act, authorizes grants to states to increase access to home and community long-term services and supports (LTSS). The three objectives of BIP, according to the Centers for Medicare & Medicaid Services (CMS) are: 1) lowering costs through improved systems performance and efficiency; 2) creating tools to help consumers with care planning and assessment; and 3) improving quality measurement and oversight.

BIP is available to any state that spends under 50% of its Medicaid LTSS expenditures on LTSS in the home and community. Any state that spends under 25% is eligible for a 5% enhanced FMAP, while any state that pends between 25% and 50% is eligible for 2% enhanced FMAP. States that receive these funds can only use these funds for home and community LTSS.

States must also complete the following structural changes by October 1, 2015: 1) No Wrong Door/Single Entry Point (NWD/SEP) System; 2) Core Standardized Assessment Instrument(s); and 3) Conflict-Free Case Management. For specifics on these three structural changes, see pages 9-31, here. Each state must submit a work plan for how it will implement these structural changes within six months following the application. For states’ approved applications and structural change workplans, click here.

As of April 2014, nineteen states have been approved for BIP: Arkansas, Connecticut, Georgia, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Mississippi, Missouri, Nevada, New Hampshire, New Jersey, New York, Ohio, and Texas.

Stakeholder Process

Ohio: Ms. Foster stated that the stakeholders had been pretty involved in bringing BIP to Ohio from the beginning. She stated that stakeholder workgroups have been in place for many years, and her association has been a member of the Front Door Stakeholder Group for five to six years.

Pennsylvania: Ms. Hoak, on the other hand, expressed frustration with the stakeholder process in Pennsylvania. While her association met with an LTC advisory group, she thought that the group, and the state, gave her association little room for public comment. Ms. Hoak claimed that the state wanted the BIP grant application submitted as soon as possible, and would be receptive to input from her association only after the application was received.

Funding and Its Disbursement

Ohio: Ms. Foster stated that Ohio was awarded $179 million in grant money for BIP. These funds were released to the state in June 2013, and Ohio starting drawing down the funds in July 2013. Ohio has until September 30, 2015 to spend all of the BIP funds.

The funds are currently being used for convening stakeholder workgroups, including the Front Door Stakeholder Group, and establishing level of care assessments (LOCs) for children. These LOCs have been tested, and the state is now working on developing LOCs for adults. The funds are also being used in procurement of an I.T. system that processes the LOCs, as well as a firewall for conflict-free case management assessment.

Ms. Sand mentioned that it is the state that is getting money for eligibility assessments and I.T. procurement, and was wondering what funds, if any, home care providers were getting.

Pennsylvania: Ms. Hoak stated that her association had been asking for BIP for four years, but Pennsylvania only applied for a BIP grant a few weeks prior to this Call with the Experts. Therefore, while Pennsylvania could have been getting funds for years, if approved, the state will only have a short period of time to spend the funds as BIP ends in 2015. She stated that when she looked at the application, she noted that all the funds slated for Pennsylvania would go to correct the existing system via funding the three structural changes required for BIP (No Wrong Door/Single Entry Point (NWD/SEP) System; Core Standardized Assessment Instrument(s); and Conflict-Free Case Management).

Is BIP Generating More HCBS?

Ohio: Ms. Foster and Ms. Sand both stated that they do not have any data on whether or not more people are being served in the home and community as a result of BIP in Ohio. Ms. Martin commented that percentage of Medicaid LTSS spending in the home and community rose from 32.5% in 2009 to 42.7% in 2013, but thinks that this increase is a result of other rebalancing changes in Ohio independent of BIP.

Pennsylvania: Ms. Hoak stated that given the above BIP expenditures in Pennsylvania, she believes the states’ goal with BIP is to first correct the existing system, and then expand the number of beneficiaries receiving home and community-based services (HCBS).


The Council plans to ask states with active BIP grants whether or not they would find a conference call on BIP beneficial, and hold a follow up Call with the Experts if so indicated. Home care agencies are advised to continue to monitor BIP in their states, and contact the Council with any questions or concerns.




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