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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

Heath 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

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

US Supreme Court Issues Important Medicaid Decision

April 1, 2015 07:49 AM

The US Supreme Court held today that Medicaid providers do not have the right to sue state Medicaid programs when a state allegedly has failed to comply with federal Medicaid law regarding the setting of payment rates. In Armstrong v. Exceptional Child Center, Inc., the Supreme Court decided that there is no private right of action under the Supremacy Clause of the U.S. Constitution for a provider of services to sue a state Medicaid program to enforce the federal Medicaid law that requires rates to be set at a level sufficient to secure access to care for Medicaid beneficiaries to the same extent available to individuals with private health insurance. You can read the opinion by clicking here. The lower courts had decided that the Idaho Medicaid program standards for rate setting violated federal law because those standards did not adequately consider the cost of care.

In a 5-4 ruling, the Supreme Court settled the latest chapter in the decades-long effort of providers of Medicaid services to challenge inadequate Medicaid payment rates in federal court.  In recent years, Medicaid providers held out hope that the court rulings in the U.S. Court of Appeals for the Ninth Circuit would become the law of the land. That court, which covers the states of California, Oregon, Arizona, Washington, and Idaho, had held that Medicaid providers could proceed to challenge Medicaid payment rates under the Supremacy Clause of the U.S. Constitution. That constitutional provision establishes that federal law preempts any conflicting state law—i.e. federal law is “supreme” to state law. The Court of Appeals had ruled that health care providers had a “private right of action” under the Supremacy Clause to enforce the “equal access” provision of federal Medicaid law as it relates to payment rates. In the Exceptional Child Center case,the Supreme Court reversed the Court of Appeals, holding that the Supremacy Clause does not grant any right of action itself. Instead, the Court held that the Supremacy Clause just tells a federal court how it must decide when there is a conflict between a state and federal law. 

The Court’s ruling also reiterated its earlier ruling that the Medicaid payment rate law itself “implicitly precludes private enforcement of” the equal access law under Medicaid. The Court found that two aspects of the equal access law establish Congress’s intent to foreclose any equitable relief for providers of Medicaid services. First, the Court concluded that the sole remedy that Congress provided is that federal Medicaid could withhold the federal funding to the state. Second, the Court further found that the equal access provision is “judicially unadministrable.” In other words, the Court considered that Medicaid rate setting requirements to be too complex for judges to adjudicate conflicts and that decisions on rate setting were better left to federal and state administrative agencies. 

The big question is where do Medicaid providers go from here to resolve conflicts regarding the adequacy of payment rates? NAHC’s Center for Health Care Law had pursued multiple lawsuits in the past on Medicaid payment rates for home care. The Exceptional Child Center case is another home care related case as it concerned payment rates for habilitation services for developmentally disabled children. Just about every other provider and practitioner sector has pursued similar litigation with most courts closing their doors to the disputes based on the absence of a provider’s right to sue.

One path open to providers is presented by Justice Stephen Breyer in his concurring opinion: ask federal Medicaid to interpret or modify existing rules or create new rules that establish federal standards that it would enforce against noncompliant state Medicaid programs. If enforcement requests are denied, an injured party (e.g., a provider of services) could seek judicial review based on refusal of the Centers for Medicare and Medicaid Services (CMS) to enforce the rules. However, as the dissenting judges point out, the only remedy that CMS can impose is to deny payment of the federal financial share of Medicaid funding, a remedy that would be self-defeating in an effort to secure access to care.

Congress can also change the law and grant providers a right to sue states when there is a problem with payment rates. While this option has appeal, Congress has shown no interest in exposing Medicaid programs to such litigation.

The other available forums for redress include the state Medicaid agency itself, the state legislature, or the state governor. However, providers have resorted to litigation because of the unresponsiveness of these Medicaid stakeholders. Still, home care has had some recent success in improving Medicaid payment rates (e.g., Colorado).

The Medicaid landscape is also shifting with many states moving towards managed care for home care and other long term care services. That means that providers should prepare to negotiate acceptable payment rates. NAHC’s Home Care and Hospice Financial Managers Association (HHFMA) is currently working on a project that will help providers accurately calculate their cost for Medicaid services as a means to prepare for evidence-based negotiation.

Medicaid home care advocates have long focused efforts outside the judicial system to address Medicaid rate issues. In light of the Supreme Court ruling, those efforts will need to continue. At the same time, it appears that directing advocacy towards the Centers for Medicaid Services at CMS should be added to the advocacy toolbox. If CMS does not properly do its job reviewing Medicaid rate-setting, the Court’s ruling may be a starting point for litigation against CMS, rather than the state Medicaid program, as the Defendant.




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