House Panel Emphasizes Shift to Home and Community-Based Care as “Key” to Improving Medicaid
July 10, 2015 08:45 AM
With the 50th Anniversary of Medicare and Medicaid taking place on July 30, the House Energy & Commerce Subcommittee on Health convened a hearing on Wednesday, July 8, to assess the Medicaid program and discuss ways to protect and improve it moving forward. The hearing was titled, “Medicaid at 50: Strengthening and Sustaining the Program.” Among the focus areas to improve the program discussed during the hearing was a greater emphasis on home and community-based care.
The hearing witnesses included Vikki Wachino, Deputy Administrator at the Centers for Medicare & Medicaid Services (CMS) and Director of the Center for Medicaid and CHIP Services; Carolyn Yocom, Health Care Director at the Government Accountability Office (GAO); and Anne Schwartz, Executive Director of the Medicaid and CHIP Payment and Access Commission (MACPAC).
In her opening statement, CMS Deputy Administrator Wachino said that one of the ways in which CMS is working with states to improve the Medicaid program is by “continuing to advance the ability of seniors and people with disabilities to receive home and community-based care.”
“CMS continues to look for ways to enable Medicaid beneficiaries with disabilities to receive home and community-based care, instead of relying on institutional care,” Wachino said. “The commitment to deliver care in ways that improve both efficiency and beneficiary outcomes extends beyond the delivery of acute and outpatient care to the delivery of long term care services as well. The passage of the Affordable Care Act provides new and expanded opportunities to serve more individuals in home and community-based settings.”
Wachino further emphasized the importance of “acknowledging that the majority of Medicaid spending is in the area of long-term care services and supports” and “making sure that the delivery of these services is supported by robust data.” As result, she said, CMS is currently focused on testing “how health information technology can be implemented in this component of the Medicaid program.”
Representative Jan Shakowsky (D-IL)discussed the effort by Medicaid to shift individuals from institutions to community-based care. Wachino affirmed that beneficiaries report that they want to remain in their homes and communities, and that Medicaid waivers have made it easier for enrollees to receive care at home. She also cited recent reforms which would make it easier for enrollees to hire and fire direct care workers. She reiterated CMS’ commitment to increasing spending on community-based care.
“One of the most important elements of long-term care has been community-based care,” said Shakowsky. Shakowsky highlighted the fact that today 51 percent of long-term care spending under Medicaid is spent on community-based care as opposed 33 percent 10 years ago.
“We hear consistently from beneficiaries that they want to remain in their communities, they want to remain active, and they want to remain with their families as much as possible,” Wachino said, affirming the importance of home and community-based care. “The proof is in the pudding, as you say, and seeing the equalization of spending on institutional care versus home and community-based care is a very major advance in modernization in our program and we’re gonna keep at it and move the needle further.”
In its 2015 Legislative Blueprint for Action, the National Association for Home Care & Hospice has provided a number of recommendations for improving Medicaid beneficiaries’ access to home and community-based care, including shifting the necessary resources to support increased long-term care services under Medicaid.