80/20 Provision in Biden’s Medicaid Plan Sparks Debate

President Joe Biden has recently put forth a plan aiming at enhancing caregiver support and reducing the number of individuals on Medicaid home care waiting lists. The plan, however, has stirred up debate among home care providers due to the inclusion of the 80/20 provision in the Medicaid Access Rule.

Currently under the scrutiny of the Office of Management and Budget, the rule stipulates that 80% of Medicaid payments for home health, homemaker, and personal care services be directed towards employee compensation.

• Industry Backlash

  This provision has drawn criticism from industry advocates who argue that it could potentially increase workforce issues rather than alleviate them. The concerns stem from the belief that this rule could potentially hurt smaller providers and disproportionately affect providers based on which states they’re operating in.

  Experts have also expressed worry that providers who cannot afford to allocate 80% of their Medicaid dollars to employee wages may have to cut staff or services to remain active or leave the Medicaid space altogether. This could ultimately burden patients, who could lose access to these critical services.

• Stipends for Those Offering Unpaid Care

  In addition to the 80/20 provision, Biden’s plan includes initiatives for increased investment in Medicaid home and community-based services and provides stipends and support resources for those offering unpaid care to veterans.

  The President emphasized the necessity to enhance conditions for care workers, stating, “The cost of care is too high, and pay for care workers is much too low.”

• Industry Sentiment

  Despite the controversy surrounding the 80/20 provision, industry advocates have expressed their readiness to collaborate with the President to identify the most effective strategies, moving forward. However, concerns persist about the rule’s potential impact on older adults’ access to care and services.

• Addressing the Waiting List Issue

  Biden also spotlighted the issue of extensive waiting lists for home-based Medicaid services, committing to expand Medicaid home care services and reduce the current backlog of 700,000 individuals.

  He stated that this initiative would enable more people to live and work in their communities with dignity and independence while ensuring improved pay and benefits for home care workers.

Key Takeaways

The President’s plan signifies a major stride toward improving conditions for caregivers and those awaiting home care services. However, the controversial 80/20 provision has elicited concerns among industry advocates regarding its potential impact on the workforce and access to care.

As the rule’s finalization is awaited, the home care community remains dedicated to collaborating with the administration to ensure the best outcomes for all parties involved.

Ultimately, the plan’s success will depend on its implementation and the industry’s capacity to adapt to these changes.

Source: HHCN

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