The Centers for Medicare & Medicaid Services (CMS) recently published a proposed rule to advance CMS' efforts to improve access to care, quality, and health outcomes for Medicaid recipients, including those receiving home- and community-based services (HCBS). The proposed rule, Medicaid Program: Ensuring Access to Medicaid Services, was published in the Federal Register on May 3, 2023.

As discussed in HCAF's spring Home Care Connection series, the proposed rule includes positive policy developments. Among them are new state reporting requirements that improve transparency and advisement from stakeholders about Medicaid reimbursement rates. Additionally, CMS would establish an incident management system and grievance process for HCBS and require states to report on their waiting lists (e.g., the period of time between approval of service and the actual start of service). The proposed rule advocates for these standards regardless of whether the service is provided under state fee-for-service (FFS) coverage or managed care coverage.

While these provisions are in line with the equal access provision and are positive policy developments, HCAF is concerned about a specific proposal for states to require that at least 80% of all Medicaid payments, including but not limited to base payments and supplemental payments, be used to compensate direct care workers who provide homemaker, home health, and personal care services. CMS' proposal requires providers to attribute 80% of the payment for these Medicaid services to compensation, which includes wages, overtime pay, payroll taxes, and certain benefits (e.g., health and dental insurance, sick leave, tuition reimbursement, etc.). All other expenses would be covered by the other 20% of the payment. This requirement would take effect four years after the effective date.

Direct care workers play a crucial role in providing vital care to Medicaid recipients, enabling our aging population to maintain dignity and independence as they age in place. Unfortunately, these workers are significantly underpaid due to outdated and insufficient Medicaid reimbursement rates, as evidenced by the alarming 77% turnover rate in 2022. Regrettably, the proposed rule's "one-size-fits-all" approach to addressing challenges within the Medicaid program fails to recognize the substantial adverse effects it could have on both providers and patients. By finalizing the rule as proposed, Medicaid recipients will be more likely to be hospitalized and institutionalized, and increased expenditures on Medicaid will result in a greater burden on American taxpayers.

CMS welcomes public comments through July 3, 2023. While HCAF will submit comments on behalf of the Florida Medicaid provider community, we strongly encourage all stakeholders to participate and share their input.

The HCAF Legislative Action Center provides stakeholders with a more comprehensive overview of the proposed rule as well as supporting information to assist them in formulating and submitting comments to CMS. Please click here to access the toolkit and submit your comments.

For more information, please contact Kyle Simon, Director of Government Affairs and Communications, at (850) 222-8967 or ksimon@homecarefla.org.