Election Outcome is Encouraging for Home-Based Care Providers, Stakeholders Say

McKnights Home Care / By Adam Healy
 
Tuesday’s general election brought sweeping change. Former president Donald Trump won the race to become the 47th president of the United States and Republicans won the majority of seats in the US Senate. For home care providers, this Republican tide may yield positive outcomes for the industry, leaders said Wednesday during a webinar hosted by Axxess and the National Alliance for Care at Home.

“The great news for us as an alliance is that our work is bipartisan and bicameral,” Steve Landers, MD, chief executive officer of the Alliance, said. “We are about things that are universally needed and essential for people of all political backgrounds. Supporting people in their homes is something that all families care about, and we believe that we’ll be able to work with the current Congress and administration as they step out, and the new one to advance these priorities. There’s a lot of work to do.” 

Earlier in the day, Katie Smith Sloan, president and CEO of LeadingAge, offered a similar reaction to the election.

“As a nonpartisan organization, LeadingAge is steadfast in our commitment to work with Congress and the administration, regardless of party affiliation,” she said in a statement. “Near-term, we will focus on working with the Trump transition teams to share LeadingAge’s agenda and to gain a clear understanding of the new administration’s housing, aging, health- and long-term care goals. As we learn more, we’ll have a better understanding of their potential impact on our members and those they serve — wherever they call home. That’s our top priority in the short term.” 

The Home Care Association of America also expressed its interest in working with the new leadership in a statement.

“HCAOA is committed to making home care more accessible and affordable and looks forward to collaborating with all policymakers, including President-elect Trump and Congress, to enact or enhance policies that efficiently and effectively meet the needs of seniors and those in need,” HCAOA CEO Jason Lee said in a statement. 

The work

Home care plans to advocate across the government. In the executive branch, president-elect Trump already has outlined a plan to support the senior care industry with tax credits and reduced red tape. Home care stakeholders have emphasized the importance of working with the new administration to improve reimbursement rates and reduce regulatory burdens.

In Congress, Republican control may give home care providers more allies, according to Andrew Woods, chairman of strategic consulting firm Liberty Partners Group. He said during Wednesday’s webinar that numerous Republican lawmakers have worked for years to bring predictability and stability for home care, promoting greater access to services nationwide.

Providers can expect Sen. Susan Collins (R-ME), who has in the past supported bills such as the Preserving Access to Home Health Act and the Choose Home Care Act, to continue fighting for positive change in home health, Woods noted. Collins will also become chair of the Senate Appropriations Committee, which will give her additional power to affect change. Providers also have an ally in Sen. Thom Tillis (R-NC), who earlier this year co-signed a letter advocating against the 80/20 provision of the Centers for Medicare & Medicaid Services’ Medicaid Access Rule….

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Insurers Prep for Trump Admin Friendly to Medicare Advantage and Mergers, Hostile to Medicaid and ACA

Fierce Healthcare / By Noah Tong

President Donald Trump has won back the White House, and with his win, many health plans are seeing their stocks rise.

Likely expecting a more relaxed regulatory environment that loosens requirements on Medicare Advantage plans and encourages more mergers, some health insurers are reaping initial benefits.

At the time of publication, CVS Health’s stock is up 11.24%, Humana is up 8.56% and UnitedHealth Group 6.03% higher. Elevance Health is seeing a modest 1.23% gain.
Today, CVS recorded $87 million in profit for the third quarter and beat the Street’s expectations. This year, the company has brought in $3 billion in profit, down from $6.3 billion at this time in 2023.

President Joe Biden has faced criticism from insurer-backed trade groups that portray him as an opponent to private insurance plans because of new federal rules seeking to hold Medicare Advantage plans to stronger standards. This caused the country’s top insurers to report, along with staggering profits, struggles tied to increased utilization and stricter federal requirements.

President Trump, on the other hand, is likely to be more favorable to MA plans. Although he distanced from Project 2025 on the campaign trail, the Heritage Foundation-led plan is closely tied to officials that will almost certainly be in or advising his transition team and second term.

The 922-page document explicitly calls for making MA the “default enrollment option” and eliminating “burdensome policies that micromanage MA plans.” It also says the current risk adjustment model should be “reconfigured.”

MA supporters say the program delivers high-quality care and more robust benefits not offered under traditional Medicare.

Critics say the program is costly and hands the keys over to insurers to impose harsh prior authorization and step therapy decisions on a whim. Some experience trouble switching from an MA plan back to traditional Medicare and others say they are faced with ghost networks, where a host of seemingly-available providers are not covered after all.

And despite some support from J.D. Vance and a select group of Republicans, it’s unlikely Federal Trade Commission Chair Lina Khan will remain at her post in a Trump administration. Although pharmacy benefit reform may continue, because it appears to be a rare bipartisan agreement in Congress, other healthcare mergers and acquisitions could get greenlit that may not otherwise seen the light of day in a President Kamala Harris administration….

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Docs to See Medicare Pay Cut Nearly 3% Next Year

Axios / By Maya Goldman
 
It's official: Doctors face another year of pay cuts from Medicare in 2025 under a rule finalized by the Biden administration on Friday, unless Congress steps in again to avert the decrease. 

• Medicare administrators also said payments for hospital outpatient services will increase slightly next year.

 
The big picture: Physicians will see a 2.9% decrease in their average Medicare payment rates next year, tracking with what the administration first proposed in July.

• Medicare law prevents the program from making annual inflation adjustments to doctor payments like it does for hospitals, nursing homes and other health providers.
• Meanwhile, physician operating costs will increase an estimated 3.5% in 2025, the rule said. 

 
State of play: Lawmakers last week released a bill that would avert the cut and give doctors a partial inflationary boost of 1.8%. 

• Congress will likely pass legislation in a post-election session with a temporary "doc fix" to keep at least some portion of the cuts from taking effect, Axios Victoria Knight reported first on Pro.

 
What they're saying: "For physician practices operating on small margins already, this means it is harder to acquire new equipment, harder to retain staff, harder to take on new Medicare patients, and harder to keep the doors open, particularly in rural and underserved areas," American Medical Association president Bruce Scott said in a statement. 
 
Zoom out: Hospital outpatient departments will see a 2.9% increase in Medicare reimbursement next year, amounting to an extra $2.2 billion for the industry, regulators also announced.

• Home health providers' Medicare payment will increase by 0.5% ($85 million) compared with this year. 
• Home health lobbyists said the final policy makes it difficult for agencies to keep up with rising costs, and urged Congress to fix their Medicare payment system as well. 

 
Additionally, the Biden administration finalized new maternal health safety standards for hospitals that offer obstetrical services, though the requirement will be phased in over a longer period of time than originally proposed. 

• The American Hospital Association said it appreciated the extended implementation timeline but believes the maternal health policy is still too punitive.

HCBS Waiting Lists Remain ‘An Incomplete Picture Of Need’

Home Health Care News / By Joyce Famakinwa
 
The number of states with waiting lists for people in need of home- and community-based services (HCBS) hasn’t seen much variation between 2016 and 2024, according to a new data analysis from the KFF.
In fact, there have been about 700,000 people on waiting lists, or interest lists, in most years since 2016. 
 
Total enrollment in waiting lists went up by 2.6% between 2023 and 2024. Currently, there are more than 710,000 people on waiting lists. 
 
When looking at individual states, 14 saw a decrease in the number of people on waiting lists, and 19 saw an increase.
 
KFF’s analysis noted that some of these changes can be explained by some states not screening for Medicaid eligibility before putting people on these lists. 
 
“Changes in this policy may result in changes in waiting list volumes,” KFF wrote. “For example, between 2018 and 2020, the total number of people on waiting lists decreased by 155,000 or 19%. However, nearly half of that change came from Ohio’s implementation of a waiting list assessment of waiver eligibility, which reduced the size of the state’s waiting list by nearly 70,000 people.”
 
Since 2016, more than half of people on waiting lists were based in states that don’t screen for eligibility. 
 
“One reason waiting lists provide an incomplete picture of need is that not all people on waiting lists will be eligible for services,” KFF wrote. “Interviews about HCBS waiting lists found that when waiver services are provided on a first-come, first-served basis, people enrolled in waiting lists are in anticipation of future need.” 
 
KFF’s analysis also offered insight into the people on these waiting lists. 
 
People living with intellectual or developmental disabilities made up 89% of waiting lists in states that didn’t screen for eligibility, and 49% in states that don’t screen prior to putting someone on the list.
 
Additionally, seniors and adults with physical disabilities made up 24% of waiting lists. 
In terms of average wait time, people on the wait lists typically accessed services after about 40 months. This is a decrease from 45 months in 2021, but an increase from 36 months in 2023.
 
As federal funding for HCBS from the American Rescue Plan Act (ARPA) begins to dry up, it might become more challenging to address waiting lists, according to KFF…

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