WASHINGTON, D.C. (December 8, 2020)—The National Association for Home Care & Hospice (NAHC) has joined with other likeminded organizations to urgently ask Congress to consider the overlooked needs of the disabled and elderly when considering any upcoming COVID relief.
None of the legislation that Congress has ultimately passed has included any dedicated funding for Home and Community-Based Services (HCBS) upon which people with disabilities and older adults rely to stay safe in their own homes and communities. Since the beginning of the pandemic, people with disabilities and older adults are particularly at risk as COVID-19 spreads across the country, facing high risk of complications and death if exposed to the virus and needing to isolate to protect themselves. Homecare advocacy groups have sent several letters from national and state organizations highlighting the urgent needs of the disability community and service systems, and specifically highlighting the need for dedicated funding for HCBS.
Whatever package comes together in December to support the needs of the country in the face of the pandemic, this dedicated HCBS funding must be included, said NAHC in a press release. This funding is crucial as state HCBS programs must continue to provide these life-sustaining daily in-home services even as they face staff shortages due to sickness, self-isolation, childcare needs, low wages, and the fact that HCBS service workers have struggled to get protective equipment even in the face of higher infection risk. These services are critical to keeping people with disabilities and older adults out of nursing homes and other institutions, where COVID-19 infections and deaths are significantly more likely.
As states face budget crises, they are responding by making cuts to Medicaid, particularly for optional services like HCBS. Simultaneously, with a growing number of uninsured in the country, state Medicaid agencies expect, as happens in countercyclical downturns, an increase in enrollment. That is why, during a pandemic, dedicated funding is necessary to maintain the stability of the program. Without a dedicated funding stream like that offered by the targeted FMAP enhancement included in section 30103 of the HEROES Act, states may not be able to sustain vital HCBS that people with disabilities and aging adults rely on to stay safely in their homes and communities and lower the risks of infection that are inherent in institutions.
Several other programs are also set to expire in December that support access to HCBS and limit the risk of unnecessary institutionalization, including the Money Follows the Person (MFP) program and HCBS Spousal Impoverishment Protections. Over the past several years there have been seven short-term reauthorizations of MFP. This has led to a destabilization of a program that saved money and helped over 105,000 individuals with disabilities and aging adults move out of institutions, nursing homes and other congregate settings to the community. Several states have already stopped transitions under MFP or even dropped out of the program entirely while awaiting the assurance of long-term funding, including nine states that closed their programs during the pandemic due to lack of funding despite rampant COVID-19 infections and deaths in institutional settings.
The MFP program provides enhanced funding to states to help transition individuals who want to move out of institutional care and back to the community. The enhanced funding states receive assists with the costs of transitioning people back to the community, including identifying and coordinating affordable and accessible housing and providing additional services and supports to make successful transitions. MFP has consistently led to positive outcomes for people with disabilities and older adults and shown cost-savings to states since it was passed with strong bi-partisan support in 2005. The Centers for Medicare & Medicaid Services (CMS) found an average cost savings of $22,080 in the first year per older adult participant, $21,396 for people with physical disabilities, and $48,156 for people with intellectual disabilities.
The MFP program works, and without it, people with disabilities and older adults would be stuck in institutions and other segregated settings. The most recent empirical analyses suggest that after five years of operating an MFP demonstration, approximately 25% of older adult MFP participants and 50% of MFP participants with intellectual disabilities in 17 grantee states would not have transitioned if MFP had not been implemented. The industry is requesting a permanent reauthorization so that states know the funding is sustainable. And with more than 40% of COVID19 infections to date being in institutions, the MFP program is more critical now than ever.
This common-sense policy ensures that couples can continue to live together in their homes and communities as they age and families can stay together when caring for loved ones with disabilities and conditions such as dementia, multiple sclerosis, or traumatic brain injury. But it is set to expire at the end of this year.
NAHC also urged that funding be extended for Medicare outreach and enrollment efforts to low-income beneficiaries, many of whom are dually eligible for Medicaid. These efforts, originally authorized in 2008 and extended nine times since then, enable Medicare beneficiaries with the least resources to access assistance for prescription drug coverage and other essential Medicare benefits for which they are eligible. Almost 3 million beneficiaries eligible for prescription drug low-income subsidies (LIS/Extra Help) are not enrolled. Previous allocations for low-income outreach and enrollment activities have led to important, proven results, including increasing the number of low-income Medicare beneficiaries enrolled in the Medicare Savings Programs from 6.4 million in 2008 to 9.2 million as of December 2019.
NAHC urges Congress to continue their efforts to incorporate the above priorities as they negotiate any COVID-19 relief, as well as the funding packages. Congress must act to address the serious, destabilizing deficits facing the nation’s only publicly funded long term care system by including both the targeted enhanced FMAP as well as a permanent reauthorization of the Money Follows the Person and HCBS Spousal Impoverishment program.
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