Skip to Main Content
National Association for Home Care & Hospice
Twitter Facebook Pintrest
A A A
Print

Testimonials

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 element...it’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

CMS and Truven Release LTSS Expenditures Report

June 3, 2014 10:42 AM

On April 28, the Centers for Medicare & Medicaid Services and Truven Health Analytics released a report titled Medicaid Expenditures for Long-Term Services and Supports in FFY 2012 (the Report).  Key findings of the Report with regard to home and community-based services (HCBS) expenditures, and rebalancing away from institutional long-term services and supports (LTSS) towards HCBS, are discussed below.

HCBS Expenditures

Total HCBS. Total HCBS expenditures experienced moderate growth increases approximating two percent each year from FFY 2010 ($66.4 billion) to FFY 2011 ($67.7 billion) and FFY 2012 ($69.3 billion). In contrast, rates of growth in total HCBS expenditures between FFY 2007 to FFY 2010 were between 10.6 and 14.7 percent. For details, including an itemized list of total HCBS expenditures, see Table A, here.

Out of the total $69.3 billion in HCBS spending in FFY 2012, the states with the top five expenditures were: New York ($12.1 billion), California ($8.3 billion), Texas ($3.8 billion), Pennsylvania ($3,2 billion), and Minnesota ($2.8 billion). For details on HCBS expenditures, see Table C, here.

The $69.3 billion of HCBS expenditures in FFY 2012 was spent in many subcategories, including the following:

1915(c) Waivers. $39.3 billion was spent in 1915(c) waivers. The states with the top five expenditures in this subcategory were: New York ($5.8 billion), Pennsylvania ($2.8 billion), California ($2.3 billion), Ohio ($2.0 billion), and Minnesota ($1.9 billion). For details on 1915(c) waivers, see Table C, here.

Personal Care Services. $12.0 billion was spent in personal care services. The states with the top five expenditures in this subcategory were: New York ($3.8 billion), California ($2.0 billion), Texas ($1.8 billion), Massachusetts ($843 million), and Minnesota ($577 million). For details on personal care services, see Table C, here. For a recent council brief on personal care services utilization, click here.

Home Health. $5.1 billion was spent in home health. The states with the top five expenditures in this subcategory were: New York ($1.8 billion), Ohio ($381 million), Massachusetts ($340 million), Connecticut ($253 million), and Texas ($224 million). For home health expenditure details, see Table L, here.

Community First Choice. $2.9 billion was in spent Community First Choice, with all of that money spent in California.

PACE. $1.0 billion was spent in the Program of All-Inclusive Care for the Elderly (PACE). The states with the top five expenditures in this subcategory were: New York ($236 million), California ($150 million), Pennsylvania ($149 million), Massachusetts ($110 million) and Colorado ($91 million). For details on PACE expenditures, see Table P, here. For a recent Council article on PACE, click here.

Private Duty Nursing. $700 million was spent in private duty nursing. The states with the top five expenditures in this subcategory were: Florida ($153 million), Minnesota ($96 million), Maryland ($88 million), North Carolina ($72 million), and Ohio ($60 million). For details on private duty nursing expenditures, see Table Q, here.

Money Follows the Person. $329 million was spent in Money Follows the Person. The states with the top five expenditures in this subcategory were: Texas ($66.4 million), Ohio ($28.3 million), New York ($22.9 million), Georgia ($21.7 million), and Maryland ($20.5 million). For details Money Follows the Person expenditures, see Table W, here. For a recent Council article on Money Follows the Person, click here.

Rebalancing

According to the Report, in federal fiscal year (FFY) 2012, Medicaid spent nearly half (49.5 percent) of its $140 billion long-term services and supports (LTSS) spend on home and community-based services (HCBS). HCBS expenditures as a percentage of total LTSS expenditures remained relatively constant from 2010 and 2011, which both had rates of 48 percent. However, HCBS has historically risen as a percentage of total LTSS spending, from 24 percent in 1997, to 30 percent in 2002, and 41 percent in 2007. For the full 1995-2012 trend, see figure 3, here.

State statistics. During FFY 2012, 23 states (including Washington, D.C.) saw Medicaid HCBS expenditures account for over 50 percent of total Medicaid LTSS expenditures, while seven of those states saw such rates at over 60 percent, and two of those states saw rates over 70 percent. The states with the top five rates were Oregon, Minnesota, Alaska, Vermont, and Arizona, while the states with the bottom five rates were Michigan, Florida, Indiana, Mississippi, and New Jersey. For details, see figure 4 and Table AK, here.

For recent state rebalancing statistics among the elderly and physically disabled population, see AARP’s scorecard, here.

The Report also looked at the states with the greatest jump in percentage increase of Medicaid LTSS spend going to HCBS, with Massachusetts and Delaware seeing an increase surpassing 10 percent, while Virginia, Ohio, Maine, Rhode Island, Alabama, Tennessee, Georgia, and New Hampshire saw increases ranging from 4.4 to 7.8 percent. For details, see figure 5, here.

Developmentally Disabled.  In FFY 2012, rebalancing was the most pronounced among the developmentally disabled population; 70 percent of Medicaid LTSS spending in this group was in HCBS) The states that had rebalanced the most successfully with regard to their developmentally disabled population were Arizona, Michigan, Oregon, and Maryland (each with 100 percent rebalancing rates), and Vermont with a 99.2 percent rate. The states with the worst rebalancing rate for this population were Arkansas (50.4 percent), Texas (50.0 percent), Louisiana (48.3 percent), Illinois (47.8 percent), and Mississippi (14.0 percent).

In FFY 2012, per resident state expenditures for 1915(c) Waivers for People with Developmental Disabilities were greatest in New York ($282.61), Maine ($236.80), Washington, DC ($234.04), Connecticut ($218.65), and North Dakota ($193.81). For details on per resident and total expenditures for all states, see Table Y, here.

Elderly or People with Physical Disabilities.  In FFY 2012, the rebalancing rate of the elderly or those with physical disabilities was 39 percent nationally. The states that had rebalanced the most successfully with regard to the elderly or people with physical disabilities population were Minnesota (65.4 percent), Alaska (62.4 percent), Washington (61.7 percent), Oregon (60.7 percent), and California (57.1 percent). The sates with the worst rebalancing rate for this population were South Dakota (16.3 percent), New Jersey (15.7 percent), Alabama (15.2 percent), Kentucky (14.4 percent), and North Dakota (14.0 percent).

In FFY 2012, per resident state expenditures for 1915(c) Waivers for the Elderly and/or People with Physical Disabilities were greatest in Minnesota ($139.59), District of Columbia ($133.60), Alaska ($125.76), Oregon ($114.13), and Washington ($81.28). For details on per resident and total expenditures for all states, see Table Z, here.

Serious Emotional Disturbance or Serious Mental Illness. In FFY 2012, the rebalancing rate of those with serious emotional disturbance or serious mental illness was 35 percent nationally. The states that had rebalanced the most successfully with regard to the serious emotional disturbance or serious mental population were: Hawaii (100 percent), Vermont (97.2 percent), Rhode Island (96.1 percent), Colorado (88.6 percent), and North Carolina (87.4 percent). The states with the worst rebalancing rate for this population were Alaska, Florida, Idaho, Kentucky, Minnesota, Nebraska, Ohio, Oklahoma, Tennessee, Virginia, and Washington (all tied with 0.0 percent).

In FFY 2012, per resident state expenditures for 1915(c) Waivers for those with Serious Emotional Disturbance or Serious Mental Illness were greatest in Colorado ($5.07), Wisconsin ($4.37), New York ($3.82), Montana ($3.11), and Iowa ($2.55). For details on per resident and total expenditures for all states, see Table AA, here.

Conclusion

Home care companies should take note that a significant business opportunity lies in providing HCBS to the elderly and physically disabled populations; according to the Report, only 39 of these populations’ LTSS expenditures are currently in HCBS.

The Report also reflects a recent slower pace of rebalancing, and the fact that 26 states still have Medicaid HCBS expenditures accounting for less than 50 percent of all their state’s Medicaid LTSS expenditures. These trends give a greater urgency to providers to continue advocating for mechanisms to improve access to HCBS services through their state associations, as well as through state and federal governments. Stakeholders should give special attention towards HCBS reform for the elderly and physically disabled populations.

Home care providers are encouraged to keep abreast of HCBS developments in their states, and nationally, and to contact the National Council on Medicaid Home Care – a NAHC affiliate - with any questions or concerns.

 

Back

 










©  National Association for Home Care & Hospice. All Rights Reserved.