Home Health & Hospice

New bipartisan bill intends to expand homecare access for older Americans

Homecare Insider, March 23, 2015

A bipartisan bill introduced by two U.S. senators aims to increase home health access for low-income elders who use the Medicare benefit to help keep these individuals out of costlier and less-desired institutionalized care settings like nursing homes.

The proposed legislation, introduced earlier this month by Senators Chuck Grassley (R-Iowa) and Ben Cardin (D-Maryland)—both members of the Senate Finance Health Care Subcommittee—is intended to kick start the federal government’s funding of long-term services and supports. Currently, backing for such care is only available to individuals poor enough to qualify for Medicaid.
Under this system, older Americans often go into a nursing home and spend down their assets until they become eligible for Medicaid to cover their long-term care, according to a written statement released on Grassley’s website.
“Everybody wants to stay in their own home as long as they can,” Grassley said in the statement. “Unfortunately, our current system doesn’t have a bridge for those who are on a fixed income but would have to sell their house to become eligible for Medicaid and get nursing home care.”
To close this gap, the statement explains that the new bill would sets the stage for a Community-Based Institutional Special Needs Plan demonstration project to facilitate the provision of home- and community-based care to low-income, Medicare-only beneficiaries who need help with two or more activities of daily living—characteristics that would often land them in a nursing home today.
At first, the demonstration would operate in up to five states, building on Medicare Advantage plans that have experience caring for this frail population. These plans would tailor services to beneficiaries, depending on individual needs (e.g., bathing assistance, housekeeping or transportation, or respite care for a primary caregiver). 
Grassley and Cardin also hope the demo project would generate evidence to support an alternative payment methodology that could produce savings for both states and the federal government.
One estimate shows four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members—the result of the bill’s anticipated ability to postpone or prevent hospitalizations and institutionalizations.
“Allowing seniors to age in place, to stay in their homes as long as possible, takes an enormous financial and emotional burden off of families,” said Senator Cardin in the statement. “This community based approach gives seniors the support and dignity they deserve and is a commonsense alternative to costly institutionalization.”