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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

HHS Releases Study Showing HCBS Wait List Effects on Costs, Institutionalization

June 13, 2014 12:05 PM

The U.S. Department of Health and Human Services (HHS) recently released a study titled Impacts of Waiting Periods for Home and Community-Based Services on Consumers and Medicaid Long-Term Care Costs in Iowa (the Study). The Study sought to examine the extent waiting for Home and Community-Based Services (HCBS) impacts nursing home stays, hospitalizations, and overall Medicaid long-term services and supports (LTSS) spending. HHS chose Iowa for the Study as ample waiver application data was available, and this data included waiting periods ranging from 3 to 25 months.


According to sources cited in the Study, 1915(c) HCBS waiver enrollment has increased at a rate of 6 percent each year; by 2009, there were 3.3 million 1915(c) HCBS enrollees. However, by 2011, “a little over half a million people” were on waiting lists nationally, with an average wait time to receive services at approximately two years.

The Study aimed to answer the following questions:

  • Do longer wait times for HCBS services increase incidences of nursing home stays and acute care hospitalizations?
  • Do longer wait times for HCBS services increase Medicaid LTSS spending?
  • Are the above increases more pronounced for those who are high-risk for nursing home placement at the time of their waiver application?

The Waivers

The Study looked at data on waiver applicants in Iowa from January 2002 through September 2007. It analyzed data from three waivers for the non-elderly adult population: the Brain Injury (BI), Health and Disability (H & D), and Physical Disability (PD) waivers. All waivers require nursing home eligibility. Additionally, BI enrollees must have an applicable brain injury. H &D enrollees must have income above 100 percent but not higher than 300 percent of the Supplemental Security Income (SSI) threshold for Iowa. PD enrollees must not be eligible for the Intellectual Disability (ID) waiver, be able to self-direct their services, have a physical disability, and be over the age of 18.

All three waivers provide: emergency response services, home and vehicle modifications, in addition to personal care services for both activities of daily living and instrumental activities of daily living. Additionally, the BI waiver provides supported employment services and community living, while the H & D waiver also provides homemaker services, respite, and meals. Per beneficiary per month (PBPM) expenditures of each waiver are capped at $2,868 for the BI waiver, between $922 and $3,267 for the H&D waiver, depending on the qualifying level of care, and $672 for the PD waiver.

In Iowa, people receive HCBS waiver services and are placed off of the waiting lists on a first come, first served basis. Priority is not given to individuals with greater need.


The Study analyzed waiting list applicants after 36 months of first applying in terms of: 1) actual enrollment in the waiver services; 2) long-term nursing home stays (90 days or more); 3) acute care hospitalizations; and 4) total monthly Medicaid LTSS expenditures.

Enrollment. Applicants that had a short wait time for waiver services (six months or less) enrolled for waiver services at a rate of 65 percent, while those who had a long wait time (exceeding six months) only enrolled at a rate of 42 percent. The individual waivers also saw higher enrollments comparing the short wait group with the long wait group (Bi waiver: 69 percent vs. 50 percent, H&D Waiver 65 percent vs. 42 percent), and PD Waiver (53 percent vs. 36 percent). For details, see Table A.6, here.

Nursing home stays. Those who faced short wait times had a statistically significant lower risk of having a long-term nursing home stay than those facing long wait times (7.6 percent vs. 10.1 percent, p = 0.07), with the most pronounced difference among the BI waiver applicants (5.5 percent vs. 10.4 percent, p = 0.04). Among the population at high-risk of being placed in a nursing home due to their age, the difference between the short and long wait times was greater (7.2 percent versus 13.9 percent, p = 0.01), with the most pronounced difference among the PD waiver applicants (12.2 percent vs. 16.6 percent, p = 0.02). For details, see Table IV.2, here.

Acute Care Hospitalizations. The Study showed that wait time did not have a statistically significant effect on hospitalizations. For details, see Table IV.3, here.

Medicaid LTSS Expenditures.  Application waiver costs. PBPM expenditures for services associated with the application waiver were $122 greater among those with short wait times versus those with longer wait times (p < 0.01) for all waiver groups. This was expected given that quicker access to HCBS would generate more expenditures. The same p values were seen in the individual waiver groups as well ($247 greater in the BI waiver population, $105 greater in the H & D waiver population, and $42 greater in the PD waiver population), as well as among both the high-risk ($146 higher) and low-risk ($101) pools.

Other waiver costs. The data also suggest that beneficiaries spend more in other waivers while they are waiting to receive the waiver services for which they are applying. PBPM Medicaid LTSS expenditures increased by $52 (p = 0.02) for all waiver groups, and there was also a statistically significant increase of $134 (p = 0.03) among the BI waiver population. The higher risk group experienced other waiver costs higher by $58 (p = 0.01), and there was also a significant increase of $115 among the BI waiver population.

Long-term nursing home stay costs. PBPM expenditures for long-term nursing home stays was lower by $56 (p = 0.09) for all waiver groups, and there was also a statistically significant PBPM cost savings of $132 for the BI waiver group. Among all waivers, the short wait group saw PBPM savings of $111 (p = 0.01), and there was also a statistically significant PBPM cost savings of $152 for the PD waiver group.

For details, see Table IV.4, here.


The National Council on Medicaid Home Care – a NAHC affiliate - voices concern about the continued growth of the waitlists nationally. In recent news, Michigan Gov. Rick Snyder announced his intention to eliminate the wait lists in his state, and North Carolina’s waitlists were profiled.

While the Study didn’t show that wait lists had a statistically significant impact on hospitalizations, it did show that longer stays contributed to a rise in nursing home stays as well as costs associated with those stays. While most of those on waitlists currently reside in the home and community, 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.





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