The CMS has released guidance that encourages states to use Medicaid funds to keep elderly and physically and mentally disabled beneficiaries at home and in community-based settings instead of nursing homes.
The agency hopes the document will remedy a longstanding imbalance between institutional and home and community-based care, it said. There is evidence that's already taking place. Data for fiscal year 2014, the last year available, showed that 53% of total Medicaid long-term services and supports (LTSS) expenditures were spent on home and community-based services compared to 45% in 2009.
Total federal and state Medicaid LTSS spending was about $152 billion in 2014, up 4% from $146 billion the year before.
The document suggests states establish an open registry of home care workers to make it easier for beneficiaries to find them, outlines qualifications these workers should have, and suggests developing adequate payment rates for home care services.
Patient advocates say it's a good move, especially for workers.
“We know that turnover is very high among personal care attendants in particular and home care providers in general,” said Sita Diehl, director of policy and state outreach for National Alliance on Mental Illness, adding that improving recruitment and retention aids quality of care.
“Keeping the same attendant promotes trust, a crucial factor for people living with mental health conditions,” Diehl said.
Industry stakeholders responded similarly. "The guidance recognizes that state Medicaid programs need to consider that low payment rates can impede access to care,” said William Dombi, vice president of law for the National Association for Homecare and Hospice, which represents home health agencies. “We hope the state Medicaid programs take the guidance seriously.”
Lilly Hummel, senior director of policy at The National Center for Assisted Living said she hopes this isn't just a way for CMS to find cheaper options to care.
Last year, the median annual cost for nursing facility care was $91,250, according to the Kaiser Family Foundation. The median cost for one year of home health aide services, one the other hand, was less than $46,000.
Hummel noted there are some instances where nursing home care leads to better outcomes. She pointed out a 2014 study that appeared in the journal Health Services Research that found seniors getting supports and services at home were more likely to be hospitalized than those living in nursing homes, even though those in nursing facilities are often sicker than those in the community.