NAHC Analysis: Medicaid Unwinding Impacting Thousands of Older Adults and People with Disabilities

Beginning in April, state Medicaid agencies have begun disenrolling individuals from the program for the first time since 2020 due to the end of COVID-era eligibility requirements. This “unwinding” process represents one of the largest issues in Medicaid policy, with an estimated 15-20 million individuals likely to lose Medicaid coverage over the next 12 months.

According to a recent report from the Kaiser Family Foundation, at least 3.8 million individuals have already been removed from Medicaid in the 41 states where data is available. CMS communications and resulting news articles have heavily emphasized the impact of unwinding on children and families. However, the unwinding process is also impacting many older adults and people with disabilities who must also renew their coverage for the first time in three years.

According to a NAHC analysis, in the 22 states where data is available on the specific populations, at least 76,630 older adults and people with disabilities lost Medicaid coverage. This represents approximately 5% of the disenrollments in these states; however, it likely undercounts the actual number of older adults and people with disabilities who were removed from the program. Most of the 22 states included in the sample do not specifically identify older adults and people with disabilities in their Medicaid unwinding data. Therefore, the calculations were based upon aggregate changes in enrollment for these populations, which does not account for routine growth in the programs.

The proportion of individuals in these categories disenrolled from the program were higher in those states that specifically broke out those groups for reporting. For example, data indicated that older adults and people with disabilities represented 11% of disenrollments in Virginia, 15% New Jersey, 8% in Missouri, and 9% in Massachusetts.

Medicaid termination is particularly impactful for older adults and people with disabilities, given that many of the long-term services and supports provided by the program are not available in Medicare or private insurance. Homecare providers can support individuals by ensuring that they are aware of the redetermination processes underway, know where to provide updated information, and make sure that all requested documentation is returned in a timely manner. For more information, visit the NAHC and United HealthCare joint renewal resource and webinar at: https://www.uhccommunityandstate.com/content/articles/an-all-hands-on-deck-approach-to-redeterminations

Input Needed: CMS Seeking Comments on Accessing Home Health Aide Services

CMS is now seeking public comments in an effort to better understand challenges facing Medicare beneficiaries in accessing home health aide services. The request for input is included as part of a proposed rule that sets forth routine updates to Medicare’s home health payment rates for 2024.

CMS is seeking this feedback to help ensure appropriate access to and provision of home health aide services for all beneficiaries receiving care under the home health benefit. Specifically, CMS seeks feedback on a number of questions, including:

• · Why is the use of home health aides declining even though there’s still strong need for those services?
• · To what extent are people eligible for Medicare who have multiple or more severe impairments having more difficulty accessing home health care services, specifically home health aide services?
• · What are notable barriers or obstacles that home health agencies (HHAs) experience in recruiting and retaining home health aides? What steps could HHAs take to improve the recruitment and retention of home health aides? 
• · Are HHAs paying home health aides less than equivalent positions in other care settings and if so, why?
• · How effective is the coordination between Medicare and Medicaid to ensure adequate access to home health aide services? 
• · What are the consequences of beneficiary difficulty in accessing home health aide services?

Comments can be submitted online or by mail until 5:00 PM ET on August 29, 2023. 

The Pandemic’s Lasting Hospice Referral Impacts

Hospice News | By Holly Vossel

Pandemic-related headwinds that strained hospice referrals may have lingering impacts on how providers are approaching their community outreach and marketing efforts.

Referrals from assisted living and skilled nursing facilities represent a large portion of hospice patients, along with hospital and health system referrals. Limited access to facility-based settings during the pandemic caused hospice referral volumes to drop significantly, posing financial and operational challenges for many providers.

Though some hospices have begun to see improvement as restrictions eased with the end of the public health emergency (PHE) on May 11, others continue to struggle toward a referral rebound.

The “new normal” of hospice referrals may be shifting, according to Susan Ponder-Stansel, president and CEO of Alivia Care. Hospice referral streams may be seeing lasting shifts as a result of trends that pre-dated COVID, including growing patient preferences to receive end-of-life care in the home setting, she said.

“A lot of providers are trying not to make any irrevocable decisions, because it is a strange time with nothing as it was,” Ponder-Stansel told Hospice News. “There’s a lot less demand for facility-based general inpatient care and more demand for continuous home hospice care. Nursing home populations are down, we’re seeing shorter lengths of stay and more acutely ill patients getting referred much later. We don’t know if that’s going to even out in this first year post-pandemic.”

The pandemic’s temporary impacts could “drastically change” access that patients, families and referral sources have to high-quality, home-based hospice care, according to Jeffrey Marsh, senior vice president and chief growth officer at Compassus.

Hospitals and health systems that saw patient demand skyrocket amid high levels of staffing burnout and turnover have increasingly recognized the value of diversifying with home-based hospice and palliative care services, he said.

“The pandemic solidified home-based care as essential to the future of health care,” Marsh told Hospice News in an email. “Since then, we have seen more hospitals, health systems and payers recognize the need to offer diverse care options that begin and end in the home. Hospice and palliative care providers have the opportunity to re-engage in the communities they serve and reestablish these services as essential components of care.”

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Home Health Patients Benefit Significantly From Seeing The Same Nurse Consistently

Home Health Care News | By Patrick Filbin
 
When patients face language barriers, having the same home health nurse across the care timeline significantly decreases hospital readmissions.
 
That’s according to a new study from New York University’s Rory Meyers College of Nursing.
 
“If you have a nurse who can consistently work with the same patient and their family members — and utilize interpreter services — you could have the same effects as if you have a nurse who speaks the same language as the patient,” Allison Squires, a professor at NYU, told Home Health Care News.
 
One of the challenges of home health care, Squires noted, is that there is often a reliance on per diem nurses. In that case, different nurses come in and out of a patient’s home and the lack of a personalized care program can have an ill effect on those patients.
 
Having a full-time nurse who is consistently in the home pays off in the long run.
 
In this study, Squires and her colleagues collected and looked through data from over 22,000 patients who were receiving home health care in New York City following a hospitalization. The patients spoke Spanish, Korean, Chinese or Russian as their primary language.
 
Of the 22,103 patients, 20.4% were re-hospitalized while 79.6% ended their home health period without a rehospitalization.
 
Of those patients:
 
– 47% had low continuity of care and language concordance
 
– 39% had high continuity of care and low language concordance
 
– 11% had high continuity of care and language concordance
 
– 3% had low continuity of care and high language concordance.
 
“Our model showed that in all instances where continuity of care was high, there was a significantly decreased rate of readmission,” the study’s authors wrote. “In addition, when continuity of care was low despite high language concordance, there was not a significant relationship. From this, we conclude that — regarding hospital readmission from home health care — continuity of care is of greater importance than language concordance for home health visits.”

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