CMS Issues Guidance on Additional Support for Medicaid HCBS

The Centers for Medicare & Medicaid Services (CMS) issued additional guidance to states with regards to the HCBS 10 percent federal medical assistance percentage (FMAP), which was included as part of the American Rescue Plan. As a reminder, this is a temporary increase to the FMAP for certain qualifying Medicaid expenditures for home and community-based services (HCBS) and is meant to supplement and not supplant existing state funds. CMS guidance is directing states to use the funds to enhance, expand, or strengthen activities within home and community-based services under the Medicaid program.

While the original communications regarding the temporary FMAP increased left out mention of Private Duty Nursing Services (PDN), NAHC was pleased to see that CMS took our initial comments to heart and made it a point to explicitly include PDN as an eligible service.

With the issuance of this guidance, it now falls on the states to create their plans for the temporary FMAP increase and we encourage everyone to work with your applicable state associations to ensure the plans are inclusive of the needs of the private duty home care community.

Passage of the American Rescue Act of 2021

On Wednesday, March 10, the U.S. House of Representatives approved the American Rescue Plan Act of 2021, following the Senate’s approval of the bill over the weekend. The American Rescue Plan (ARP) Act is the sweeping COVID-19 relief package identified by President Biden as his top legislative priority in the early days of his administration. The law contains $1.9 trillion in new spending, the largest stimulus ever approved by Congress. The legislation includes provisions addressing issues within public health, labor, and small business, as well as many other aspects of the country.

In past COVID-19 relief packages NAHC was successful in advocating for provisions positively impacting home care and hospice providers. That trend continued with the American Rescue Plan through significant funding to the Medicaid HCBS program and additional provider relief funds allocated to rural services. Following is a summary of the provisions of not to home care and hospice providers.

Medicaid HCBS Funding

In past relief packages NAHC and Congressional Champions were left frustrated by the lack of funds and attention given to home and community based services (HCBS) in the Medicaid program. The ARP will provide for a 10% increase for one year starting on April 1st to the Federal Medical Assistance Program (FMAP), the federal share of Medicaid, specifically for HCBS. These funds can be applied towards:

  • Home Health Care services
  • Personal care services
  • PACE services
  • HCBS Services
  • Case Management services
  • Rehab services

While there is excitement around the 10% one year increase as it equates to approximately $12.67 billion, it is important for providers to remember that the 10% increase is temporary. It cannot be characterized necessarily as a reimbursement rate increase. However, states can use it to fund a reimbursement rate increase, among other options.

The only requirement is that it must be used for Home and Community-Based Services. The major thing that providers must watch out for is that IF it is used to fund a rate increase, this increase would expire as of March 31, 2022, and if the state chooses to not keep funding the increase, it will disappear altogether.

Rural Provider Relief Fund Allocation

$8.5 billion has been allocated in provider relief funds specifically for rural providers. The original draft of the legislation limited this provision to providers located in rural areas. NAHC worked with Congress and was successful in changing the provision to open eligibility up to providers that may be located in urban areas, but serve patients in rural areas.


$12.2 billion has been provided to increase vaccination supplies and distribution capacity designed to speed up vaccine administration.

These provisions will prove very helpful to home care and hospice providers in the coming days. While NAHC is grateful to Congress for their action in the ARP, there is still more that can be done to support home care and hospice patients, and the providers of care. NAHC will continue to prioritize further suspension of the Medicare sequester, and passage of the HEAT Act that would provide for telehealth reimbursement in home health, and the Choose Home proposal that would create an enhanced home health benefit serving as an alternative to the skilled nursing facility benefit.

Individual Stimulus Check

$1400 direct payments to individuals are included for those making less than $75, 000 per year or couples making less than $150,000. Additional money is offered for each of their dependent children. The direct payments are phased out for earners at the $80,000 level for individuals, and $160,000 level for couples.

Federal Unemployment Assistance

The law extends $300 federal weekly enhanced unemployment benefit through September 6, 2021. Additionally, the first $10,200 of the UI becomes tax-free for individuals who earn up to $150,000 annually.

Congress Approves American Rescue Plan Act with Key Features for HCBS

President Biden to sign the bill into law on Thursday, March 11 On Wednesday, March 10, the U.S. House of Representatives approved the American Rescue Plan Act of 2021, following the Senate’s approval of the bill over the weekend. The American Rescue Plan (ARP) Act is the sweeping COVID-19 relief package identified by President Biden…