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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

The Future of Medicaid: A NAHC Perspective

August 11, 2017 09:36 AM

Following seven months of repeal and replace talks, the final three in the Senate, efforts to come up with an alternative to the Affordable Care Act failed in dramatic fashion when Senators Susan Collins (Maine), John McCain (Arizona), and Lisa Murkowski (Alaska) voted against the so called “skinny repeal.” This resulted in a 49-51 vote count as all Democrats voted against the measure as well. As has been reported, the National Association for Home Care and Hospice’s (NAHC) primary concerns with these bills was the significant cuts that would have been made to the Medicaid program. Ultimately, these proposed funding cuts would lead to the removal of home care and hospice as benefits under Medicaid.

As long as there is a United States Congress and a Medicaid program there will be contingent of lawmakers interested in reforming it – specifically, shifting the federal share to a defined contribution. The appeal here is for ease of budgeting, short-term savings, and potentially long-term savings as well. Opponents of this approach argue that enrollees will be harmed by inevitable funding cuts and benefit reductions. The two options discussed in this most recent round of Medicaid reform discussions were block grants and per capita caps. While similar in the intent of a defined federal contribution, these models operate differently. Block grants are a simple lump sum payment to each state individually for the state to determine how to spend on their Medicaid program with few stipulations.

In a per capita cap model, which is the model lawmakers included in the repeal-and-replace legislation, states would be allotted a specific amount per enrollee from the federal government, not the open ended amount that currently exists. Starting in 2020, the federal share would have been based on 2016 data, and then adjusted for inflation annually, according to the Consumer Price Index (CPI). Put into public policy, these adjustments would result in a funding gap widening with each passing year from what Medicaid is currently projected to spend, as its growth rate exceeds what the CPI calls for.

This decreased level of funding paired with home care and hospice’s status as optional benefits, and nursing homes status as a mandatory benefit puts state governments into an undesirable position. They will be pressured to come up with additional funding, cut home care and/or hospice as a benefit in favor of nursing homes, or hamper the eligibility criteria. All of these options would do great harm to patients and providers of home care and hospice.

In the future, we anticipate a continued desire to reform Medicaid from Congress in an effort to cut spending. However, as we just witnessed, there will be strong opposition to these proposals. As many know, there is a stereotype that exists that Medicaid only covers people looking for a “free ride” and those that refuse to work. Data simply does not validate those assertions. Studies have shown the vast majority of Medicaid beneficiaries are either working, seeking work, students, disabled, or providing care to a loved one. Further, Medicaid ensures care for the most vulnerable among us. People living with disabilities, seniors who have exhausted their savings and retirement funds, and those that have experienced financial catastrophe from unforeseen medical emergencies, are all Medicaid beneficiaries. Protecting these people is vital to NAHC’s mission.

In future debate, NAHC urges lawmakers to strengthen eligibility protections for vulnerable populations. We recommend that home care and hospice be made mandatory benefits under Medicaid. We also urge lawmakers to ensure proper funding is protected so that no enrollee is denied home care or hospice. If a system such as per capita caps or block grants were put in place, an inflation adjustment factor that keeps pace with states Medicaid expenses is essential to the achievement of optimal outcomes and patient satisfaction. A more recent payment baseline, rather than four years prior, would also be paramount to a strong foundation for block grants and per capita caps.

It is no secret that President Trump and Secretary of Health and Human Services Tom Price hold the ACA in low regard. With repeal and replace talks on ice, these two are now looking at other avenues to reform the American health care system. One notable way is through state Medicaid waivers. While these waivers were created with good intent, expanding coverage, they do not include additional funding. This scenario creates an undesirable catch-22, covering new enrollees while hurting current enrollees. State governments are able to expand coverage through reducing benefits offered and implementing cost sharing requirements such as deductibles and copays. It is difficult to make specific recommendations on waivers as there are countless ways in which they may be planned and implemented. As such, NAHC urges careful deliberation and open dialogue with stakeholder groups when leaders consider these proposals. Further, Congress should closely monitor these proposals develop to ensure no harm is done. Some states have already applied for, and been granted these waivers, with Maine becoming the most recent to apply. Expect more states to follow. 

For over 30 years, NAHC has worked and advocated for the rebalancing of post-acute care spending in favor of the home, away from institutional settings. Every president, dating back to Ronald Reagan, has agreed and supported care in the home. Numerous pieces of legislation passed by Congress have shown their support for rebalancing. In 2015 these efforts were realized with the majority of post acute care spending going towards home and community based care. Most recently, both Republican and Democratic policy platforms from the 2016 election cycle specifically prioritized home care. NAHC applauds these inclusions and looks forward to further progress in favoring home and community-based services. 




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