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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

Medicaid Proposals Contained in the President’s FY16 Budget

February 6, 2015 03:53 PM

President Obama recently submitted his FY16 budget to Congress. Although many lawmakers in the Republican-controlled House and Senate proclaimed the budget dead on arrival, some of the President’s proposals could have a significant impact on upcoming Congressional budget deliberations.

Many of the provisions included in his budget that would affect the home care and hospice community are similar to proposals from previous years. NAHC Report recently highlighted Medicare provisions contained in the President’s budget – including the continued call for additional cuts to home care payments and the misguided proposal to implement a “sick tax” in the form of a home health copayment. While there are some proposals that raise serious concerns within the Medicare components of President Obama’s budget, the Medicaid provisions are mostly beneficial to home and community-based care.

The Budget includes legislative proposals in Medicaid which have a net impact of $3.7 billion on federal spending over 10 years, including $26.7 billion in Medicaid investments to make the program, according to the Administration, “more flexible, efficient, and accountable.”  The Budget extends and refocuses the rate increase for Medicaid primary care providers. The Budget also extends free preventive care services to all Medicaid beneficiaries, creates a new state plan option to provide continuous Medicaid coverage and limit churn, expands access to home and community-based long-term care services and supports, and provides permanent flexibility to facilitate enrollment of children into Medicaid.

Below is an analysis of some of the most significant Medicaid proposals in the President’s FY16 budget. 

Advancing Comprehensive Medicaid Long-Term Care

The Budget proposes an eight-year pilot program to create a Medicaid comprehensive long-term care state plan option for up to five states. Participating states would be authorized to provide long-term care services across the continuum of care under one authority, creating equal access to home and community-based care and nursing facility care. The Secretary would have the discretion to make these pilots permanent at the end of the eight years. This proposal works to end the institutional bias in long-term care and simplify state administration. [$4.1 billion in costs over ten years].

Improve and Extend Money Follows the Person Rebalancing Demonstration

This proposal would extend the Money Follows the Person demonstration period through FY 2020 to enable states to continue to rebalance their long-term care systems and transition individuals to home and community-based services as well as providing additional flexibility to states to support individuals remaining in the community within the existing appropriation.

Currently, individuals must enter institutions to qualify for covered home and community based services in the Money Follows the Person Demonstration. To support individuals remaining in the community, this proposal would modify the demonstration to allow funds to be used to prevent individuals from entering an institution in the first place, as well as transition services.

This proposal would also reduce the institutional requirement from 90 to 60 days and allow skilled nursing facility days to be counted towards the institutional requirement.

Lastly, this proposal would allow individuals in certain mental health facilities to transition to home and community-based services under the demonstration.

[No budget impact].

Expand Eligibility Under the Community First Choice Option

This proposal would provide states with the option to make medical assistance available to individuals who would be eligible under the state plan if they were in a nursing facility.  Under current law, any state interested in the Community First Choice Option must create or maintain a 1915 © waiver with at least one waiver service to make the benefit available to the special income group or provide eligibility for the Community First Choice benefit through another eligibility pathway.  This approach is administratively burdensome for states.  This proposal would provide equal access to services under the state plan option and provide states with additional tools to manage their long-term home and community-based service delivery systems. ($3.6 billion in costs over 10 years)

Allow Full Medicaid Benefits for Individuals in a Home and Community-Based Services State Plan Option

Thisproposal would provide states with the option to offerfull Medicaid eligibility to medically needy individualswho access home and community-based servicesthrough the state plan option under section 1915(i) ofthe Social Security Act.

Under current law, when astate elects to not apply the community income and resource rules for the medically needy, these individuals can only receive 1915(i) services and no other Medicaid services. This option will provide states with more opportunities to support the comprehensive health care needs of individuals with disabilities and the elderly. [$38 million in costs over 10 years].

Create Pilot to Expand PACE Eligibility to Individuals between Ages 21 and 55

This program provides comprehensive long-term services and supports to Medicaid and Medicare beneficiaries through an interdisciplinary team of health professionals who provide coordinated care to beneficiaries in the community. For most participants, the comprehensive service package includes medical and social services and enables them to receive care in the community rather than to receive care in a nursing home or other facility. Under current law, the program is limited to individuals who are 55 years old or older and who meet, among other requirements, the state’s nursing facility level of care.

This proposal would create a pilot demonstration in selected states to expand eligibility to qualifying individuals between 21 years and 55 years of age. This effort would test whether the Program for All-Inclusive Care for the Elderly can effectively serve a younger population without increasing costs. The pilot would promote access to community services in line with the integration of the landmark Olmstead Supreme Court decision, supporting self-determination and achieving better health outcomes. [No budget impact].

Allow States to Develop Age-Specific Health Home Programs

The Affordable Care Act includes a provision that allows states to create Health Homes for Medicaid enrollees with chronic conditions. Under a Health Home program, states can develop a comprehensive system of care coordination for the purpose of integrating and coordinating all primary, acute, behavioral health, and long-term services and supports to treat the whole person. States receive an increased federal match for Health Home services for the first eight quarters of their program.

This proposal would allow states to target their Health Home programs by age. Currently, states are required to cover Health Home services for all categorically needy individuals with the specified chronic condition(s), regardless of age. Many states have voiced support for allowing age-specific targeting of their Health Home model to better serve the needs of youth with chronic conditions. [$1 billion in costs over 10 years]

Expand Medicaid Fraud Control Unit Review to Additional Care Settings

The Budget proposes to allow Medicaid Fraud Control Units to receive federal matching funds for the investigation or prosecution of abuse and neglect in non-institutional settings, such as home-based care—in which a beneficiary may be harmed in the course of receiving health care services. The current limitation on federal matching was established in 1978, at a time when Medicaid services were typically provided in an institutional setting, but does not reflect the shift in delivery and payment for health services to in-home and community based settings. [No budget impact, but $66 million in non-PAYGO savings over 10 years].

There are numerous other provisions – covering both Medicare and Medicaid program integrity, pilot programs and new initiatives – that may be of interest to the home care and hospice community. These additional provisions will be analyzed in a future NAHC Report article.

While it is unlikely that the President’s HHS budget will be approved as is by Congress, it does offer a starting point for discussions on the size and scope of the Department for the coming year. As Congress considers and debates President Obama’s 2016 budget, it is important for NAHC members to contact their elected officials urging them to oppose home health payment cuts as well as the implementation of a “sick tax” in the form of a home health copayment.

Please click here to contact your elected officials on these important topics.

To see how HHS’ budget allocation was received on Capitol Hill, please see NAHC Report, February 6, 2015.




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