Legislation to Extend Key Homecare Programs Proposed in Senate

WASHINGTON, D.C. (January 17, 2020)—Bipartisan leadership of the Senate Finance Committee has announced proposed legislation providing for the extension of several programs within Medicare and Medicaid. Commonly referred to as an “extenders package” the legislation provides for the continuation of programs that are currently on track to exhaust their current funding allocation. Notable to homecare and hospice providers are the extension of three programs: the Medicaid Money Follows the Person (MFP) Rebalancing Demonstration, protections against spousal impoverishment in home and community-based services (HCBS), and the independence at home demonstration.

The National Association for Home Care & Hospice has long-supported the MFP demonstration and the spousal impoverishment protections in HCBS as they both work to allow Medicaid beneficiaries to stay independent in their homes. MFP is designed to work towards a rebalancing of Medicaid expenditures on long-term services and supports in favor of home- and community-based settings, and away from institutional settings. Funds are awarded to state Medicaid programs to spend on efforts that will allow recipients to reside in the community. This could include personal care services for activities of daily living and instrumental activities of daily living, home modifications, and transportation. While some of this spending is outside the normal bounds of the Medicaid program, MFP has demonstrated overall savings compared to the institutional alternative. Further, the MFP program allows Medicaid beneficiaries to reside in the setting of their choosing maintaining a higher quality of life and the opportunity to maintain their sense of independence and dignity.

Protections against spousal impoverishment have long existed for the spouse of a Medicaid beneficiary residing in a nursing home. It wasn’t until the Affordable Care Act in 2009 that they were extended to the spouse of a home- and community-based service recipient. Unfortunately, this new coverage was not made permanent and has since needed ongoing extensions. The basis of the issue is that when a person becomes eligible for and uses long-term services and supports their combined assets with their spouse must be spent down to a certain level before Medicaid will begin to provide coverage. This in effect impoverishes the spouse that is not receiving care. Spousal impoverishment protections allow for a certain level of assets for the spouse not receiving long-term services and support care.

Independence at Home is a demonstration project of the Center for Medicare & Medicaid Innovation (CMMI) to test the delivery of home-based primary care (HBPC). It uses interdisciplinary teams to coordinate all medical and social services in eligible patients’ homes, providing high quality clinical care and excellent patient experience, while reducing total Medicare costs. Certain Medicare beneficiaries with multiple chronic conditions participate in the program, but that number has been limited to 10,000 total beneficiaries. However, Congress increased the limit on participants to 15,000 and extended the IAH program for two more years in February 2018.

This extenders package is being championed by Chairman Chuck Grassley (R-Iowa) and Ranking Member Ron Wyden (D-Oregon) of the Senate Finance Committee. The legislative language calls for making the MFP demonstration program and spousal impoverishment protections with HCBS permanent while the Independence at Home demonstration would receive a three year extension.

NAHC will continue to monitor this legislation and will update readers as developments occur.