NAHC to Senate: Health Care Reform Must Include Access to Home Care
June 16, 2017 04:10 PM
Val Halamandaris, the President of the National Association for Home Care & Hospice (NAHC) wrote a letter to the leaders of the United States Senate this week to express concern that the health care reform currently being debated in Congress does not adequately address the vast and growing home care needs of America’s rapidly aging population.
The people served in home care include the most vulnerable citizens in the United States, with many receiving end of life care through hospice, essential services through home health agencies, and crucial support for Activities of Daily Living through hardworking personal care attendants and home care aides.
For more than 35 years, Congress and the Administrations under both Republican and Democrat leadership have strived to ensure that the infirm and persons with disabilities have full opportunities for care outside of an institution. Former Presidents Reagan, Bush, Clinton, Bush, and Obama all took steps to expand access to home care as a cost-effective, high quality health care solution. Throughout, these Administrations had widespread, bipartisan support from Congress. Those actions established a guiding principle for any health care or health insurance reform—access to home care is essential. Home care is the bedrock of health care and it brings security and well-being to the nation.
The U.S. still have a long way to go before we reach the stage where all impediments to care in the home are removed. Under Medicaid, 24 states still spend more on institutional care than on home care. It was not until 2015 that the balance of such spending finally favored home care over institutional care.
Still, in some states nearly 70% of Medicaid spending on long term services and supports is directed to costly nursing home services for patients who can be safely cared for with less expensive home care.
In reviewing the American Health Care Act (AHCA), as passed by the House of Representatives, there are serious concerns that access to home care is not a priority. For example, the bill eliminates an important Medicaid option, the Community First Choice benefit, which encourages states to shift spending to cost effective home care. Numerous states have embraced that new benefit. Still, the failure of some states to offer a robust home care option is evident even with the financial incentives under the Community First Choice program. The current per capita caps formula will be a roadblock to the expansion of access to home care in Medicaid. The elimination of the Community First Choice benefit is, as well.
Nowhere in the House bill is home care presented as the national health policy priority that both parties have espoused for many years. Instead, the House bill presents the risk that the opportunity for Medicaid beneficiaries to receive needed care in their home will be compromised and, potentially, lost, as Medicaid home care benefits are optional.
In addition, while most states currently offer hospice services to their Medicaid populations, this benefit also remains an optional one. Absent any requirement that states offer a meaningful end-of-life benefit, imposition of caps or other limits on funding for Medicaid services will create tremendous pressure on states, and will place existing coverage of hospice care at serious risk.
NAHC respectfully recommends that the Senate take all necessary steps in its health care reform efforts to preserve and advance access to home care.
Stay tuned to NAHC Report for updates on this critical topic.