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Biden Administration Set to Implement Final Rule on Medicaid Worker Compensation

Centers for Medicare & Medicaid Services

Biden Administration Set to Implement Final Rule on Medicaid Worker Compensation


Today, Vice President Kamala Harris unveiled the long-awaited "Ensuring Access to Medicaid Services" final rule. The rule, according to the White House's announcement, aligns with the Biden-Harris Administration's pledge to enhance safety in care, expand access to long-term care, and elevate the quality of caregiving jobs.

Initially proposed in May 2023, the rule aims to bolster access to home care services and raise the standard of caregiving jobs. It addresses critical areas such as workforce compensation, access to home- and community-based services (HCBS), person-centered planning, grievance procedures, reporting requirements, and quality measures.

While expressing support for some elements, comments submitted by HCAF to the Centers for Medicare & Medicaid Services (CMS) last summer highlighted concerns about the provision mandating at least 80% of Medicaid HCBS payments to go to direct care worker compensation. This includes workers providing homemaker services, home health aide services, and personal care services. The rule, which applies to various Medicaid sections but excludes state plan personal care and home health services, is set to take effect six years after the effective date.

"We remain deeply concerned about the provision in the Ensuring Access to Medicaid Services final rule," stated HCAF Executive Director Bobby Lolley, RN. "While we appreciate efforts to enhance access to home care services and elevate caregiving job standards, this requirement raises significant operational and financial challenges for providers. We urge CMS to reconsider this provision to ensure sustainable access to essential care while maintaining fair compensation for workers."

As the final rule rolls out, HCAF is collaborating with industry partners, including the National Association for Home Care & Hospice (NAHC), for potential legislative and legal solutions due to the unique challenges that states will face in implementing the mandate.

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