Accessing Most Medicaid & CHIP Benefits Will Not Affect Immigration Status

On Thursday, September 8, 2022, the U.S. Department of Homeland Security (DHS) issued a final rule applicable to noncitizens who receive or wish to apply for benefits provided by the U.S. Department of Health and Human Services (HHS) and States that support low-income families and adults. The rule, which details how DHS will interpret the…

HHS Expands HCBS for Elderly, People with Disabilities

More than 40 states and territories will now participate in Medicaid’s Money Follows the Person demonstration program, which has provided billions to help seniors and people with disabilities safely transition from institutional care to their homes and communities On August 23, 2022, the U.S. Department of Health and Human Services (HHS), through the Centers for…

Feds Extends American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

  • States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities,” said CMS Administrator Chiquita Brooks-LaSure.

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

Feds Extend American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

  • States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services

On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year — through March 31, 2025 — to use funding made available by the American Rescue Plan (ARP) to enhance, expand, and strengthen home- and community-based services (HCBS) for people with Medicaid who need long-term services and supports.

“This is very good news,” said NAHC President William A. Dombi. “The ARPA funds are desperately need in Medicaid HCBS but using those founds properly has been a complex undertaking for the states. The added time to use the funds is very welcome.”

As the primary funder of HCBS nationally, Medicaid plays a critical role in supporting states’ efforts to strengthen these services for their beneficiaries. Section 9817 of the American Rescue Plan provides states with a temporary 10 percentage point increase to the federal medical assistance percentage (FMAP) for certain Medicaid expenditures for HCBS — an estimated $12.7 billion. As a result of the ARP increase in the federal matching rate on activities, states originally had a three-year period — from April 1, 2021 through March 31, 2024 — to use the available state funds, attributable to the ARP’s increased FMAP, on activities to enhance, expand, or strengthen HCBS in Medicaid. The extended timeframe, of an additional year, will help to facilitate high-quality, cost-effective, person-centered services for people with Medicaid. This will allow Medicaid beneficiaries to remain in the setting of their choice—whether it is their home or another setting—and remain a valued part of their communities.

This ARP funding allows states to identify and implement changes aimed at addressing existing HCBS workforce and structural issues. It will also help expand states’ capacity to provide critical services and meet the needs of family caregivers and people on HCBS waitlists. Moreover, states can use these funds to tailor HCBS activities based on the needs and priorities of their residents. For example, states can use the funds to provide additional support to address the continued impact of the COVID-19 pandemic on individuals who need long-term services and supports, who are at higher risk for contracting COVID-19, and who might otherwise be in more costly nursing homes and other institutions instead of their own homes. Some states are also using the funds to increase pay and benefits for direct service workers, which many states were unable to do before the ARP funding increase due to funding shortages and restrictions.

“Everyone deserves the dignity to live in their own homes and communities, and the Biden-Harris Administration is committed to protecting that right,” said HHS Secretary Xavier Becerra. “Thanks to extended funding from President Biden’s American Rescue Plan, we are expanding home- and community-based services for millions of aging Americans and people with disabilities across the country. We are working hand-in-hand with states to ensure they have the time and support they need to strengthen their home care systems and workforce.”

“With this extension, we are addressing states’ concerns, giving states the time and resources to strengthen connections to care at home and in communities,” said CMS Administrator Chiquita Brooks-LaSure.

The COVID-19 pandemic has exposed the risks of institutional and congregate settings for older Americans and people with disabilities, underscoring the urgent need to expand access to high-quality HCBS to improve outcomes for people who need long-term services and supports. HCBS allow millions of Medicaid beneficiaries to receive services in their own home or community rather than institutions or other isolated settings.

Critical safeguards are in place through the ARP legislation and CMS’ guidance to certify that these funds are used appropriately. Between now and the March 2025 deadline, CMS will continue to monitor states’ progress and compliance to ensure funding is used to strengthen HCBS under their Medicaid program.

Additional information on states’ spending plans — including a recently updated infographic summarizing planned activities and key investments — can be found at Medicaid.gov https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

To review the guidelines for the use of the ARP funds, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd21003.pdf.

To review the State Medicaid Director Letter extending the spending deadline, please visit: https://www.medicaid.gov/federal-policy-guidance/downloads/smd22002.pdf.

Feds Extend American Rescue Plan Spending Deadline for States to Expand Medicaid HCBS

States will have an additional year to use American Rescue Plan funds to strengthen the home care workforce and expand access to services On Friday, June 3, the U.S. Department of Health and Human Services (HHS), through the Centers for Medicare & Medicaid Services (CMS), is notifying states that they now have an additional year…

Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation

United States Surgeon General Dr. Vivek Murthy issued a new Surgeon General’s Advisory highlighting the urgent need to address the health worker burnout crisis across the country. Health workers, including physicians, nurses, community and public health workers, nurse aides, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading to crisis levels of burnout.

The pandemic further exacerbated burnout for health workers, with many risking and sacrificing their own lives in the service of others while responding to a public health crisis.

The Surgeon General’s Advisory Addressing Health Worker Burnout lays out recommendations for health care organizations, health insurers, health technology companies, policymakers, academic institutions, researchers, and communities to address health worker burnout and ensure their well-being – so that health workers can thrive and better answer their call as healers.

Topline recommendations to address burnout in the Surgeon General’s Advisory include:

  • Transform workplace culture to empower health workers and be responsive to their voices and needs.
    • We can begin by listening to health workers and seek their involvement to improve processes, workflows, and organizational culture.
  • Eliminate punitive policies for seeking mental health and substance use disorder care.
    • Ensure on-demand counseling and after work hours care are more accessible to health workers to promote and preserve their well-being.
  • Protect the health, safety, and well-being of all health workers. 
    • Provide living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including childcare and care for older adults for all health workers.
    • Ensure adequate staffing, including surge capacity for public health emergencies, that is representative of the communities they serve. This is critical to protect and sustain health workers and communities.
    • Organizations, communities, and policies must prioritize protecting health workers from workplace violence and ensure that they have sufficient personal protective equipment.
    • In a national survey – PDF exit disclaimer icon among health workers in mid-2021, eight out of 10 experienced at least one type of workplace violence during the pandemic, with two-thirds having been verbally threatened, and one-third of nurses reporting an increase in violence compared to the previous year.
    • Among 26,174 state, tribal, local, and territorial public health workers surveyed across the country during March-April 2021, nearly a quarter (23.4%) reported feeling bullied, threatened, or harassed at work.
  • Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues.
    • One study showed that on average, for every 1 hour of direct patient care, a primary care provider will spend 2 hours a day on administrative tasks. That is time that could be spent with patients, in the community, and building relationships with colleagues, which is essential to strengthening the health and well-being of both health workers and patients.
  • Prioritize social connection and community as a core value of the healthcare system.
    • This enhances job fulfillment, protects against loneliness and isolation, and ultimately improves the quality of patient care.
    • This includes peer and team-based models of care to strengthen collaboration and create opportunities for social support and community.
  • Invest in public health and our public health workforce. 
    • Diversify and expand the public health workforce and improve disease surveillance systems to help address social determinants of health and health inequities, counter health misinformation, and strengthen partnerships across clinical and community settings.

“We applaud the Surgeon General for recognizing the increasing pressures on health care workers that is triggering burnout at a time when we are grappling with the greatest shortage ever of health care professionals,” said NAHC President William A. Dombi. “A number of the recommendations require a partnership with stakeholders such as a Medicare and Medicaid to provide improved compensation, job flexibilities, and the reduction of the burdens of paperwork. We are prepared to work constructively with HHS and others to bring practical solutions into reality. Health care professionals are essential to the future of our nation. We must act expeditiously.”

“At the height of the COVID-19 pandemic, and time and time again since, we’ve turned to our health workers to keep us safe, to comfort us, and to help us heal,” said Secretary of Health and Human Services Xavier Becerra. “We owe all health workers – from doctors to hospital custodial staff – an enormous debt. And as we can clearly see and hear throughout this Surgeon General’s Advisory, they’re telling us what our gratitude needs to look like: real support and systemic change that allows them to continue serving to the best of their abilities. I’m grateful to Surgeon General Murthy for amplifying their voices today. As the Secretary of Health and Human Services, I am working across the department and the U.S. government at-large to use available authorities and resources to provide direct help to alleviate this crisis.”

“The nation’s health depends on the well-being of our health workforce. Confronting the long-standing drivers of burnout among our health workers must be a top national priority,” said Surgeon General Vivek Murthy. “COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point. Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”

Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation

United States Surgeon General Dr. Vivek Murthy issued a new Surgeon General’s Advisory highlighting the urgent need to address the health worker burnout crisis across the country. Health workers, including physicians, nurses, community and public health workers, nurse aides, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading to crisis levels of burnout.

The pandemic further exacerbated burnout for health workers, with many risking and sacrificing their own lives in the service of others while responding to a public health crisis.

The Surgeon General’s Advisory Addressing Health Worker Burnout lays out recommendations for health care organizations, health insurers, health technology companies, policymakers, academic institutions, researchers, and communities to address health worker burnout and ensure their well-being – so that health workers can thrive and better answer their call as healers.

Topline recommendations to address burnout in the Surgeon General’s Advisory include:

  • Transform workplace culture to empower health workers and be responsive to their voices and needs.
    • We can begin by listening to health workers and seek their involvement to improve processes, workflows, and organizational culture.
  • Eliminate punitive policies for seeking mental health and substance use disorder care.
    • Ensure on-demand counseling and after work hours care are more accessible to health workers to promote and preserve their well-being.
  • Protect the health, safety, and well-being of all health workers. 
    • Provide living wages, paid sick and family leave, rest breaks, evaluation of workloads and working hours, educational debt support, and family-friendly policies including childcare and care for older adults for all health workers.
    • Ensure adequate staffing, including surge capacity for public health emergencies, that is representative of the communities they serve. This is critical to protect and sustain health workers and communities.
    • Organizations, communities, and policies must prioritize protecting health workers from workplace violence and ensure that they have sufficient personal protective equipment.
    • In a national survey – PDF exit disclaimer icon among health workers in mid-2021, eight out of 10 experienced at least one type of workplace violence during the pandemic, with two-thirds having been verbally threatened, and one-third of nurses reporting an increase in violence compared to the previous year.
    • Among 26,174 state, tribal, local, and territorial public health workers surveyed across the country during March-April 2021, nearly a quarter (23.4%) reported feeling bullied, threatened, or harassed at work.
  • Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues.
    • One study showed that on average, for every 1 hour of direct patient care, a primary care provider will spend 2 hours a day on administrative tasks. That is time that could be spent with patients, in the community, and building relationships with colleagues, which is essential to strengthening the health and well-being of both health workers and patients.
  • Prioritize social connection and community as a core value of the healthcare system.
    • This enhances job fulfillment, protects against loneliness and isolation, and ultimately improves the quality of patient care.
    • This includes peer and team-based models of care to strengthen collaboration and create opportunities for social support and community.
  • Invest in public health and our public health workforce. 
    • Diversify and expand the public health workforce and improve disease surveillance systems to help address social determinants of health and health inequities, counter health misinformation, and strengthen partnerships across clinical and community settings.

“We applaud the Surgeon General for recognizing the increasing pressures on health care workers that is triggering burnout at a time when we are grappling with the greatest shortage ever of health care professionals,” said NAHC President William A. Dombi. “A number of the recommendations require a partnership with stakeholders such as a Medicare and Medicaid to provide improved compensation, job flexibilities, and the reduction of the burdens of paperwork. We are prepared to work constructively with HHS and others to bring practical solutions into reality. Health care professionals are essential to the future of our nation. We must act expeditiously.”

“At the height of the COVID-19 pandemic, and time and time again since, we’ve turned to our health workers to keep us safe, to comfort us, and to help us heal,” said Secretary of Health and Human Services Xavier Becerra. “We owe all health workers – from doctors to hospital custodial staff – an enormous debt. And as we can clearly see and hear throughout this Surgeon General’s Advisory, they’re telling us what our gratitude needs to look like: real support and systemic change that allows them to continue serving to the best of their abilities. I’m grateful to Surgeon General Murthy for amplifying their voices today. As the Secretary of Health and Human Services, I am working across the department and the U.S. government at-large to use available authorities and resources to provide direct help to alleviate this crisis.”

“The nation’s health depends on the well-being of our health workforce. Confronting the long-standing drivers of burnout among our health workers must be a top national priority,” said Surgeon General Vivek Murthy. “COVID-19 has been a uniquely traumatic experience for the health workforce and for their families, pushing them past their breaking point. Now, we owe them a debt of gratitude and action. And if we fail to act, we will place our nation’s health at risk. This Surgeon General’s Advisory outlines how we can all help heal those who have sacrificed so much to help us heal.”

 

Surgeon General Advisory Sounds Alarm on Health Worker Burnout and Resignation

United States Surgeon General Dr. Vivek Murthy issued a new Surgeon General’s Advisory highlighting the urgent need to address the health worker burnout crisis across the country. Health workers, including physicians, nurses, community and public health workers, nurse aides, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading…

New CMS Website Will Share Innovative State Actions to Expand Medicaid HCBS

  • CMS also approves earlier application for Alabama’s section 1115 demonstration to improve access to home and community-based services

The Centers for Medicare & Medicaid Services (CMS) has launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow people enrolled in Medicaid to receive services and supports in a preferred setting outside of an institution, such as in their own home. Through this new webpage, state Medicaid agencies and stakeholders can access information about states’ plans to enhance, expand, and strengthen home and community-based services across the country using new Medicaid funding made available by the American Rescue Plan Act of 2021 (ARP).

Additionally, CMS has approved a new Medicaid section 1115 demonstration in Alabama, entitled the “Community Waiver Program,” to operate concurrently with a home and community-based services 1915(c) waiver. This new opportunity in the state’s Medicaid program will increase access to home and community-based services, and allow the state to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting.

“One-stop Shop” for Plans to Enhance, Expand, & Strengthen Home and Community-based Services

To encourage states to expand home and community-based services and strengthen their programs, the Biden-Harris Administration implemented a funding increase established by the ARP. The ARP provided states with a temporary 10 percentage point increase in federal Medicaid funding for certain Medicaid home and community-based services from April 1, 2021 through March 31, 2022, if they meet certain requirements. As the COVID-19 pandemic continues, the additional federal funding made available under the ARP allows those enrolled in Medicaid who need long-term services and supports to receive the assistance required to reside in the setting of their choice.

“The Biden-Harris Administration recognizes the value and dignity that come with access to home and community-based services,” said HHS Secretary Xavier Becerra. “Thanks to the American Rescue Plan, we can support states working to expand access to home and community-based services for Medicaid beneficiaries. With the launch of this new online hub, we’re making it easy for states to exchange ideas on how best to care for their residents.”

“The ability to access health care at home or in the community is essential for many low-income families, older adults, and individuals with disabilities who rely on Medicaid services — especially during this unprecedented public health emergency,” said CMS Administrator Chiquita Brooks-LaSure. “Thanks to the American Rescue Plan, CMS is providing state Medicaid agencies with the tools and funding needed to expand this important care. We welcome the opportunity to work with states to expand home and community-based services to meet the needs of their communities.”

The announcement issued today reinforces CMS’s commitment to assist states in response to the public health emergency. State administrators and stakeholders are encouraged to visit Medicaid.gov to view states’ programs and activities to identify innovative approaches that can support home and community-based services and improve capacity building and infrastructure in their area by drawing inspiration from other states.

For example, some states are delivering vaccines to people with disabilities and older adults through mobile COVID-19 vaccination programs. Other states are focusing on the potential of home and community-based services to help people with Medicaid coverage receive care outside a skilled nursing facility after a hospitalization, when aligned with the beneficiary’s goals. Other activities may include expanding and implementing new, community-based behavioral health crisis response services, ensuring that a qualified provider with training quickly and properly responds to mental health and substance use-related crisis situations. Many states are also providing recruitment and retention bonuses and increasing pay for direct support professionals, as well as implementing new training programs and other strategies to strengthen the direct support workforce. These actions allow Medicaid enrollees to receive care in the comfort of their own home or in a preferred community setting.

To view the home and community-based services webpage with states’ ARP section 9817 spending plans and narratives, letters issued to states on their spending plans and narratives, and other important information related to the implementation of ARP section 9817, please visit https://www.medicaid.gov/medicaid/home-community-based-services/guidance/strengthening-and-investing-home-and-community-based-services-for-medicaid-beneficiaries-american-rescue-plan-act-of-2021-section-9817-spending-plans-and-narratives/index.html.

For additional information on ARP funding for home and community-based services, see the guidance that CMS issued to states via a State Medicaid Director Letter in May of this year.

New Demonstration for Home and Community-based Services in Alabama

The Biden-Harris Administration is proud to help states that have long been at work to advance home and community-based services. Separate from the new website launched today, CMS has approved Alabama’s earlier application for a section 1115 demonstration, entitled “Community Waiver Program.” The 1115 demonstration will operate concurrently with a home and community-based services 1915(c) waiver in Alabama, a new opportunity in the state’s Medicaid program to meet the needs of additional individuals who prefer to get long-term care services and supports in their home or community rather than an institutional setting. Together, Alabama’s 1115 demonstration and 1915(c) waiver will increase access to home and community-based services for many Alabamans who are currently on a waiting list.

The state will now be able to redesign its home and community-based services delivery system to address concerns, such as long waiting lists, high use of residential services and out-of-home placements, and low integrated community employment rates among its residents. CMS will also provide the authority needed for Alabama to create a new program that supports individuals with intellectual disabilities who choose to work, live with family, or live independently.

“It is important we find ways to collaborate to help Alabamians in need, particularly those with intellectual disabilities. My Administration is pleased to offer the Community Waiver Program, which focuses on serving individuals with intellectual disabilities before they are in crisis,” said Alabama Governor Kay Ivey. “The partnership between the Alabama Department of Mental Health and the Alabama Medicaid Agency will help integrate these individuals in the community, giving them a better chance to develop skills to work and live independently.”

To view Alabama’s section 1115 demonstration approval and the new 1915(c) waiver, visit: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/101016.

New CMS Website Will Share Innovative State Actions to Expand Medicaid HCBS

CMS also approves earlier application for Alabama’s section 1115 demonstration to improve access to home and community-based services The Centers for Medicare & Medicaid Services (CMS) has launched a new “one-stop shop” for state Medicaid agencies and stakeholders on Medicaid.gov to advance transparency and innovation for home and community-based services. Home and community-based services allow…