NAHC to Congress: Minimum Wage Hikes Must Not Outpace Reimbursement Rates

On February 9th, the National Association for Home Care and Hospice sent a letter to leaders in Congress of both parties, outlining recommendations as legislators consider an increase in the minimum wage to $15 per hour. Twenty-eight state home care and hospice associations joined NAHC in signing the letter. An increase to the federal minimum…

Biden Orders Review of Trump Admin Public Charge Rule

President Biden announced on Tueday, February 2, an executive order directing federal agencies to review the previous administration’s immigration policies, including the public charge rule, which was initially proposed by the Trump administration in September 2018 and finalized it August of 2019.

Under the public charge rule the Department of Homeland Security (DHS) expanded what criteria it considered to be a public charge when evaluating an immigrant’s application for citizenship. Under the previous standard applicants could be denied if they were expected to be “primarily dependent on the government for subsistence. In expanding the criteria, DHS specified a list of prior usage of common government benefits to be taken into account for evaluation, including: temporary assistance for needy families (TANF), section 8 housing, federal housing subsidies, and certain Medicaid benefits. In addition, DHS would evaluate an applicant’s likelihood of need of public assistance in the future. These points of criteria include age, health, family size, and financial means.

This rule proved to be controversial since its proposal with many labeling it a “wealth test” for immigrants, and as a means to limit immigrants to the United States. The rule was challenged in court, eventually rising to the Supreme Court, which ultimately ruled in favor of allowing the regulation to be implemented. However, in August 2020 a federal court issued a temporary injunction that in-effect blocked implementation of the public charge regulation due to the COVID-19 pandemic. Under the injunction, as long as there is a public health emergency related to the pandemic, the regulation was barred from application, implementation, and enforcement. (See NAHC Report for more information.)

The public health emergency remains in effect, having been renewed most recently in January 2021.  

The National Association for Home Care and Hospice filed comments with DHS on the proposal expressing concerns that the rule could prove damaging to the home care and hospice providers that often rely on immigrants to work as caregivers, an occupation notoriously facing workforce shortages. It is estimated that about 30 percent of the home care workforce is comprised of people born outside the United States.

“This proposal will result in fewer eligible home care workers, as immigrants tend to serve as a sizable proportion of the personal care and assistance aides workforce,” writes NAHC in its comments on the proposed rule. “These workers often qualify for public assistance through programs such as Medicaid and the Supplemental Nutrition Assistance Program (SNAP). The typical annual income for these non-skilled workers falls below the guidelines for a two-member household as included in the proposed rule, and their eligibility for public assistance will also be counted as negative factors in determinations. Barring Immigrants on the basis of public assistance will only exacerbate an already prevalent workforce shortage leaving many employers unable to care for patients in need. This will cause patients to seek out more costly institutional settings for the same care they could have received in their home.”

“A reversal of this policy by the Biden Administration should help increase the home and community-based services workforce at a time when home care demand is rising,” said NAHC President Bill Dombi, in reaction to the news.

According to the best estimates, about 30 percent of the home care workforce is comprised of people born outside the United States, about evenly split between naturalized American citizens and non-citizen immigrants. “This is a strong indication that immigrants will play an important role in addressing the substantial workforce challenges home care will face in the coming years. According to the U.S. Bureau of Labor Statistics, home care workers rank in the top five fastest growing occupations. By 2026 the demand for home care workers is projected to increase by over one million.”

Due to low reimbursement rates offered by government programs like Medicaid or the Veterans Administration, compensation for home care workers is limited and a majority of them qualify for some form of public assistance. (About 30 percent qualify for SNAP and 30 percent qualify for Medicaid.)

The Biden executive order also rescinds a memorandum requiring family sponsors to repay the government if relatives receive public benefits. The order requires agencies to conduct a top-to-bottom review of recent regulations, policies, and guidance that have set up barriers to our legal immigration system.

CMS Answers Key Home Care Questions

The Centers for Medicare & Medicaid Services (CMS) has provided the following responses to several outstanding questions submitted by the National Association for Home Care & Hospice (NAHC) . NAHC submitted the questions after receiving requests for clarification on these issues from its membership. Question #1 There is confusion based on the regulations below. Section…

Biden Orders Review of Trump admin Public Charge Rule

President Biden announced on Tueday, February 2, an executive order directing federal agencies to review the previous administration’s immigration policies, including the public charge rule, which was initially proposed by the Trump administration in September 2018 and finalized it August of 2019. Under the public charge rule the Department of Homeland Security (DHS) expanded what criteria it considered to…

NAHC Wants Your Input for 2021 Legislative & Regulatory Agendas

The policy staff of the National Association for Home Care & Hospice (NAHC) and its affiliates — the Hospice Association of America (HAA), the Home Care & Hospice Financial Managers Association (HHFMA), and the National Medicaid Action Council — are in the process of developing their agendas for legislative and regulatory activities in the coming…

Tell Congress: Home Care Deserves Access to Provider Relief Funds

The Provider Relief Fund in the CARES Act has provided a necessary lifeline for health care providers around the country, but home care companies that do not bill Medicare and/or Medicaid have been left out of the fund distribution and NAHC believes this must change.

The fund distributions have enabled the Department of Health & Human Services (HHS) to stabilize access to care during the Public Health Emergency and help preserve the health care infrastructure for the post-pandemic future and NAHC is grateful for that. However, home care companies provide vital services to some of the most vulnerable Americans and they should be included in all future provider fund distributions. 

NAHC is asking you to CONTACT your elected officials today and urge them to ask HHS to prioritize distribution of CARES Act funds to these home care companies that serve millions of Americans with vital personal health care supports. This will take only seconds of your time and means so much to home care.

Support from the Provider Relief Fund would be consistent with other distributions that have occurred so far. These include distributions to home care agencies that provide this same care through Medicaid, Assisted Living Facilities, and behavioral health providers. Similarly, HHS has provided funding supports beyond Medicare and Medicaid providers to dentists and behavioral health providers among others. As such, the standards and structures are in place to allow these companies to apply for funding.

Please ADD YOUR VOICE to this effort and ensure all home care agencies have the opportunity to access critical funds from the CARES Act Provider Relief Fund as the pandemic continues to impact operations. We are stronger together and you can be assured that NAHC will not rest in our advocacy efforts on behalf of the entire home care community.

Every Voice, Every Heart, Every Action


NAHC Urges Feds to Make Some COVID-Era Reforms Permanent

The National Association for Home Care & Hospice (NAHC) submitted comments in response to a Department of Health and Human Services (HHS) request for information on which COVID-19-related regulatory waivers and flexibilities should be made permanent – beyond the public health emergency (PHE) or remain temporary, and lapse when the PHE is over. HHS specifically…

NAHC Analysis: Impact of COVID Relief and Spending Bill on Home Care and Hospice

President Donald J. Trump signed legislation in late December to fund U.S. federal government operations through the 2021 Fiscal Year and provide $900 billion of stimulus supports to address the impacts of the COVID-19 pandemic. NAHC offers the following summary of the over 5600 page legislation. Generally, we confine our summary to those provisions that…

A Look Ahead: Home Care and Hospice Advocacy in 2021

With the 2020 elections well in the rear-view and the seating of the new Congress and the inauguration of the 46th President fast approaching, our nation’s Capital is gearing up for what is increasingly looking like an active 2021. Traditionally, a new administration views the first 100 days of their taking office as the window…

NAHC to Congress: Fund the Lifespan Respite Care Program

The National Association for Home Care & Hospice (NAHC) has joined with other likeminded organizations to write to the Chairs and Ranking Members of the Appropriations Committees in the Senate and House of Representatives to urge Congress to fully fund Lifespan Respite Care Program, administered by the Administration on Aging, Administration for Community Living. For more…