HHS to Provide $110 Million in HCBS for Seniors & Disabled

Scroll down for more info on webinars for funding applicants The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. First authorized in 2005, MFP has provided states with $4.06 billion to…

HHS to Provide $110 Million in HCBS for Seniors & Disabled

  • Scroll down for more info on webinars for funding applicants

The Centers for Medicare & Medicaid Services (CMS) announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program.

First authorized in 2005, MFP has provided states with $4.06 billion to support people who choose to transition out of institutions and back into their homes and communities. The new Notice of Funding Opportunity (NOFO) makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

“NAHC has long supported the Money Follows the Person program,” said NAHC Director of Government Affairs Calvin McDaniel. “The announced funds will provide additional investment and opportunities for states to enhance their HCBS offerings. Continued investments in HCBS further rebalances spending on long-term services and supports in favor of the home. This investment is consistent with President Biden’s goals of improving access to care in the home. NAHC encourages the eligible states and territories to apply for these new funds.”

HCBS is a critical component of the Medicaid program and the MFP program has been a critical tool, now with the potential to do more in a broader array of states and territories.

To help additional states and territories implement MFP, these awards will support the early planning phase to get an MFP program off the ground. This includes:

  • Establishing partnerships with community stakeholders, including those representing diverse and underserved populations, Tribal entities and governments, key state and local agencies (such as state and local public housing authorities), and community-based organizations;
  • Conducting system assessments to better understand how HCBS support local residents;
  • Developing programs for the types of community transitions MFP supports;
  • Establishing or enhancing Medicaid HCBS quality improvement programs;
  • Recruiting HCBS providers as well as expert providers for transition coordination and technical assistance; and
  • Conducting a range of planning activities deemed necessary by the award recipients and approved by CMS.

State Medicaid agencies not currently participating in the MFP demonstration may apply through the NOFO no later than May 31, 2022. To access the NOFO, visit Grants.gov or here https://www.grants.gov/web/grants/view-opportunity.html?oppId=334196

For states already participating in MFP, CMS also announced that the agency is increasing the reimbursement rate for MFP “supplemental services.” These services will now be 100% federally funded with no state share. Further, CMS is expanding the definition of supplemental services to include additional services that can support an individual’s transition from an institution to the community, including short-term housing and food assistance. These changes will help further address critical barriers to community living for eligible individuals, as well as increase community transition rates and the effectiveness of the MFP demonstration overall. For more information on current and previous grantees, visit Medicaid.gov. CMS will provide additional information on these changes to MFP grantees.

“Everyone deserves the opportunity to live at home, in their communities, and with their loved ones,” said Health & Human Services (HHS) Secretary Xavier Becerra. “This funding will bring dignity and peace of mind to even more seniors and people with disabilities across the country. We will continue expanding these programs to ensure all Americans have equitable access to the high-quality health care they deserve—no matter where they live.”

Money Follows the Person Demonstration Expansion: Notice of Funding Opportunity (NOFO) Webinars for Applicants

CMS released a Notice of Funding Opportunity that will offer up to $110 million to expand access to home and community-based services (HBCS) through Medicaid’s Money Follows the Person (MFP) program. The new NOFO authorized under the Consolidated Appropriations Act of 2021 (CAA) will make individual awards of up to $5 million to states and territories that are not currently participating in MFP. These funds will support states during the initial planning and implementation of their programs.

CMS will hold two webinars to provide details about the MFP Demonstration Expansion, and to answer questions from potential applicants regarding this funding opportunity. Registration is required. The webinars will be held:

April 13, 2022 1:00 pm to 2:00 pm (ET)

Registration: Click on https://cms.zoomgov.com/j/1601853787?pwd=Vm9UTUoyRnpVVStjSEo1QlZYWURPUT09

April 27, 2022 1:00 pm to 2:00 pm (ET)

Registration: Click on  https://cms.zoomgov.com/j/1612862544?pwd=MGd3YW5nUVJ4T050bWFraTV6V0Y1UT09

Senate Debates Expansion of Medicaid HCBS

The Senate Special Committee on Aging met this week to debate the improvement and expansion of home-based services, particularly home-and-community based services, a consistent priority for committee chairman Senator Bob Casey (D-PA). Witnesses and Senators frequently cited. Casey’s Better Care Better Jobs (BCBJ) Act, strongly supported by NAHC, as it is the foundation for the HCBS provisions included in the Build Back Better (BBB) Act, the stalled health care, social service, and climate legislation that was a focus for much of 2021.

The most recent version of that legislation passed by the House of Representatives would provide $150 billion investment into Medicaid HCBS, permanency of the Money Follows the Person program, protections against spousal impoverishment for HCBS recipients, and several other policies intended to improved the provision of Medicaid HCBS.

Witnesses testimony focused on the current state of HCBS through explanation of statistics and data on the workforce, wages, patient need, and expected growth over the next eight to ten years. Witnesses highlighted the challenges that recipients are able to overcome with the assistance of home care, as well as the realities they face in the absence of care. They also highlighted challenges caregivers face in wages not competitive with other industries, feelings of isolation, and the grueling work. These accounts were paired with support for the Better Care Better Jobs Act.

While many of the witnesses lauded the HCBS funding included in the American Rescue Plan, passed in March 2021, they did add that it did not provide a permanent solution. Anne Tumlinson likened it to an “umbrella in a hurricane.”

At the hearing, the witness panel was comprised of Lisa Harootunian, Associate Director, Health Program, Bipartisan Policy Center, Anne Tumlinson, CEO, ATI Advisory, Brandon Kingsmore, Disability Advocate, Public Speaker, accompanied by Ms. Lynn Weidner, Home Care Worker, and Alene Shaheed, Home Care Recipient.

While the version of Build Back Better passed by the House is not expected to see further consideration in the Senate, work continues to be done on compiling a package of provisions consistent with the intent of BBB, though no specifics seem to be agreed to at this point.

NAHC will continue to urge Congress to make significant investments into the Medicaid HCBS program.

Congress Debates HCBS Expansion, Improvement for Veterans

The Elizabeth Dole HCBS for Veterans and Caregivers ActH.R. 6823 introduced in the U.S. House of Representatives earlier this month and would work to improve home and community-based services (HCBS) services for patients, their families, and their caregivers.

NAHC previously reported on it here.

Specifically, this legislation would:

  • Expand access to HCBS services for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.
  • Raise the cap on how much the VA can pay for the cost of home care from 65% of the cost of nursing home care to 100%.
  • Coordinate expanded VA home care programs with other VA programs.
  • Establish a pilot project to address home health aide shortages.
  • Providing respite care to caregivers of veterans enrolled in home care programs.
  • Establish a “one stop shop” webpage to centralize information for families and veterans on programs available.
  • Require the VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the Program of Comprehensive Assistance for Family Caregivers into any other home care program they may be eligible for.

Following the introduction of the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act, the House Committee on Veterans’ Affairs held a hearing on the bill, and several other pieces of legislation designed to improve the Veterans Administration (VA) and health care delivery for veterans.

In written testimony, Dr. Julianne Flynn, Acting Assistant Under Secretary for Health Care within the Veterans Health Administration offered support for numerous provisions included in H.R. 6823, in particular the increase of to 100% of what the VA can pay for home based on the cost of nursing home care. Likewise, the legislation received favorable comments from other members of the panel as well as testifying witnesses from the Elizabeth Dole Foundation and the Paralyzed Veterans of America.

NAHC supports this legislation as it will make much needed improvements for veterans receiving home care through increased accessibility, improved coordination, and caregiver support.

Senate Debates Expansion of Medicaid HCBS

The Senate Special Committee on Aging met this week to debate the improvement and expansion of home-based services, particularly home-and-community based services, a consistent priority for committee chairman Senator Bob Casey (D-PA). Witnesses and Senators frequently cited. Casey’s Better Care Better Jobs (BCBJ) Act, strongly supported by NAHC, as it is the foundation for the HCBS provisions included in the Build Back Better (BBB) Act, the stalled health care, social service, and climate legislation that was a focus for much of 2021.

The most recent version of that legislation passed by the House of Representatives would provide $150 billion investment into Medicaid HCBS, permanency of the Money Follows the Person program, protections against spousal impoverishment for HCBS recipients, and several other policies intended to improved the provision of Medicaid HCBS.

Witnesses testimony focused on the current state of HCBS through explanation of statistics and data on the workforce, wages, patient need, and expected growth over the next eight to ten years. Witnesses highlighted the challenges that recipients are able to overcome with the assistance of home care, as well as the realities they face in the absence of care. They also highlighted challenges caregivers face in wages not competitive with other industries, feelings of isolation, and the grueling work. These accounts were paired with support for the Better Care Better Jobs Act.

While many of the witnesses lauded the HCBS funding included in the American Rescue Plan, passed in March 2021, they did add that it did not provide a permanent solution. Anne Tumlinson likened it to an “umbrella in a hurricane.”

At the hearing, the witness panel was comprised of Lisa Harootunian, Associate Director, Health Program, Bipartisan Policy Center, Anne Tumlinson, CEO, ATI Advisory, Brandon Kingsmore, Disability Advocate, Public Speaker, accompanied by Ms. Lynn Weidner, Home Care Worker, and Alene Shaheed, Home Care Recipient.

While the version of Build Back Better passed by the House is not expected to see further consideration in the Senate, work continues to be done on compiling a package of provisions consistent with the intent of BBB, though no specifics seem to be agreed to at this point.

NAHC will continue to urge Congress to make significant investments into the Medicaid HCBS program.

Senate Debates Expansion of Medicaid HCBS

The Senate Special Committee on Aging met this week to debate the improvement and expansion of home-based services, particularly home-and-community based services, a consistent priority for committee chairman Senator Bob Casey (D-PA). Witnesses and Senators frequently cited. Casey’s Better Care Better Jobs (BCBJ) Act, strongly supported by NAHC, as it is the foundation for the HCBS…

Congress Debates HCBS Expansion, Improvement for Veterans

The Elizabeth Dole HCBS for Veterans and Caregivers Act, H.R. 6823 introduced in the U.S. House of Representatives earlier this month and would work to improve home and community-based services (HCBS) services for patients, their families, and their caregivers. NAHC previously reported on it here. Specifically, this legislation would: Expand access to HCBS services for veterans…

Bill to Expand HCBS for Veterans Introduced in Congress

Bipartisan legislation to ensure that veterans are able to receive care in their home for as long as possible has been introduced in the House of Representatives. The Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act of 2022 (H.R. 6823) would expand and improve expand the home and community-based services (HCBS) programs within the Department of Veterans Affairs (VA), and align public policy with improved outcomes and patient choice, which is to stay in their own home.

NAHC supports this bill, as it will make much needed improvements to the delivery of HCBS for veterans, enabling options in how and where they receive care, while also working to address workforce shortages and support family caregivers.

Specifically, this legislation would:

  • Expand access to HCBS services for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.
  • Raise the cap on how much the VA can pay for the cost of home care from 65% of the cost of nursing home care to 100%.
  • Coordinate expanded VA home care programs with other VA programs.
  • Establish a pilot project to address home health aide shortages.
  • Providing respite care to caregivers of veterans enrolled in home care programs.
  • Establish a “one stop shop” webpage to centralize information for families and veterans on programs available.
  • Require the VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the Program of Comprehensive Assistance for Family Caregivers into any other home care program they may be eligible for.

The legislation is led by Representatives Julia Brownley (D-CA) and Jack Bergman (R-MI) and NAHC thanks them for their leadership on this important issue.

At introduction, Rep. Brownley stated, “Over half of all veterans that use VA are over the age of 65, age, combined with their unique health needs, makes many elderly veterans especially vulnerable to going into nursing homes and institutional care. Our nation’s veterans deserve the right to age comfortably and with dignity in their homes.

“I introduced the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act to ensure that every veteran has access to the care they need, when and where they need it. The focus of my legislation is to keep veterans in their homes for as long as possible, if they want, bringing them the care they need to the place they feel most comfortable, and ensure that every VA medical center has these necessary support programs.

“By expanding home and community-based services, veterans will have the assistance needed to remain members of their communities, to be present in their family lives, to support their caregivers, and to age with dignity.”

Rep. Bergman added, “As the studies show and as many of the older Veterans throughout our Nation will attest, care in home settings is often preferable to care in a clinical facility. This is especially true for those disabled and elderly Veterans living in the rural and remote communities of Michigan’s First Congressional District. The Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act recognizes this reality.”

A hearing on the bill is scheduled for March 16. NAHC will update this issue.

Bill to Expand HCBS for Veterans Introduced in Congress

Bipartisan legislation to ensure that veterans are able to receive care in their home for as long as possible has been introduced in the House of Representatives. The Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act of 2022 (H.R. 6823) would expand and improve expand the home and community-based services (HCBS) programs within the…

NAHC to Congress: Big Investment in HCBS is Needed Now

The National Association for Home Care & Hospice has joined a large group of likeminded organizations in urging leaders in both houses of Congress and both parties to ensure that Medicaid Home and Community Based Services (HCBS) remain part of any package that moves forward. A large investment is essential for building a sustainable HCBS infrastructure that can begin to address the magnitude of need in our communities, both increasing access to Medicaid HCBS and addressing the direct care workforce crisis–creating more direct care jobs to support people with disabilities and aging adults, and making those jobs better.

To address the long-standing inequities the pandemic exposed and exacerbated, this investment is critical to fortify a workforce that must continue to expand to meet a rapidly increasing level of need. The HCBS workforce provides vital services, and yet these workers– who are primarily women of color–have been devalued and underpaid for decades, leading to severe staff shortages that can result in crucial gaps in service availability, lengthy waiting lists, service line closures, and additional obstacles to achieving a high quality of life for workers and recipients alike.

Due in large part to a long history of inadequate funding at the federal level, the system itself is not serving everyone who needs HCBS, even though most people far prefer to remain in their homes as they age, and research has shown that quality of life is significantly improved when individuals are able to live in the community. Further, people with disabilities of all ages have a legal right to receive services and supports in the most integrated setting, regardless of the source of payment for services. Yet, 31 years after the passage of the Americans with Disabilities Act, over 800,000 people with disabilities are currently on waiting lists for the Medicaid-funded services needed to make that possible, and many more are entering institutions against their wishes because they do not have qualified and trained direct care staff to support them in the setting of their choice. These waiting lists leave people with disabilities, aging adults and their families waiting years and even decades for services. The investments in the Build Back Better Agenda are crucial to reach this as yet unrealized goal of the Americans with Disabilities Act.

When older adults who want to age in place and people with disabilities who need support to work, live independently, and be a part of their communities are left waiting, the responsibility for care and support often falls on unpaid family caregivers, who also need financial assistance. The costs of this inadequate system fall disproportionately on people of color with limited income and wealth. The workforce and earnings losses related to unpaid family caregiving are significant and well-documented.

NAHC urges Congress to continue to include and prioritize the large investment in the infrastructure of Medicaid HCBS, and the workforce that provides them, as lawmakers negotiate any package moving forward.