Reform Update: Home-care providers fail to win sought-after ACA exemptions

The Obama administration granted many U.S. companies additional leeway in the healthcare law's mandate to provide health benefits, but home-care providers and other companies that rely heavily on Medicaid reimbursement failed to win the permanent exemption they wanted.

The U.S. Treasury Department and the Internal Revenue Service said in final regulations issued Monday that companies with 50-99 full-time employees will have until Jan. 1, 2016, to comply with the requirement. Large employers, those with 100 or more full-time workers, also won some extra time. They must provide benefits to at least 70% of their full-time employees in 2015 and have until 2016 to reach 95%.

However, the final rule did not address several requests to carve out exemptions for businesses that rely heavily on Medicaid beneficiaries. Companies that offer in-home personal care said the requirement will be particularly onerous on them.

"Although we are happy with the decision to delay the employer mandate, there are still critical issues not addressed that could have unintended harmful effects on the home care industry,” said Phil Bongiorno, executive director, Home Care Association of America.

Medicaid reimbursement rates of $10-$16 an hour don't allow home care companies to cover the expense of health benefits, the trade group says, which means its members are likely to respond by reducing workers' hours in order to duck the threshold. A lobbyist for the industry said the effect will be worse than that.

“The unanticipated consequence of the (mandate) will be forcing out a lot of personal care and home care groups that are non-profits,” said Bill Broydrick, founder of the lobbying firm Broydrick & Associates, which represents several home health companies.

Of the 10.2 million uninsured Latinos who are eligible for new coverage under the healthcare reform law, about 4.2 million may be eligible for Medicaid or CHIP and about 3.9 million may be eligible for tax credits to help them pay monthly premiums for plans sold in the exchanges, according to an HHS report (PDF) released Tuesday.

The report comes as states such as California have noticed signups by Latinos have lagged compared with enrollments of other ethnicities. Lawmakers in that state have blamed the slow signups on a lack of outreach targeting Latinos, and the lack of a Spanish-language paper application until late December, according to a report in the Los Angeles Times.

Immigrants who are living in the U.S. illegally and legal residents who have lived in the country less than five years are not eligible to get coverage under any provision of the Patient Protection and Affordable Care Act. The Kaiser Family Foundation has estimated that about 20% of the uninsured are not citizens.

Late last year, HHS indicated that six out of 10, or 4.2 million, uninsured African-Americans may be eligible for Medicaid, CHIP or exchange subsidies.

Follow Virgil Dickson on Twitter: @MHvdickson