As the pandemic has shined a light on the capabilities of home care and home health, associations are looking for the Biden administration to expand Medicaid and Medicare coverage in the space this year.  

“There’s a resurgence of interest there,” Katie Smith Sloan, president and CEO of LeadingAge, which represents home care and other long-term care providers, said. “I think we’re going to see home-based care grow in lots of different ways, and we look forward to being part of that growth.”

Sloan, who talked to McKnight’s Home Care Daily along with other association heads, noted that the Medicaid battle is at the state level.

“There has been a significant shift in many states to rebalance Medicaid dollars into HCBS,” Sloan said. “Some states have pushed more aggressively than other. I think we’ll see the trend continue.”

Besides pushing states to rebalance their Medicaid funding, William Dombi, president of the National Association of Home Care & Hospice, would like the federal government to keep an eye on rates.

“We’d also hope the feds are more engaged in how states operate the program, particularly around rate setting,” Dombi said. “They by and large pay less than the costs of care.”

Given nursing homes’ challenges during the pandemic, Vicki Hoak, executive director of the Home Care Association of America (HCAOA), believes there will be moves to expand Medicaid to cover home care.

 “I think this country is now recognizing we can do a lot for people in [their] own homes,” she said.

Home health

On the home health side, Dombi would like the Biden administration to come up with a way to reimburse home health for using telehealth, which has expanded under the Public Health Emergency waivers. He’s also like to see a Medicare benefit provide coverage for home as a skilled nursing facility alternative.

One concern of Sloan is reimbursement under Medicare Advantage.

“We want to make sure they are treating providers fairly and truly covering the cost of care,” she said.

More coverage for palliative care is another action item this year, Dombi noted.

“There is no palliative benefit under Medicare and barely under Medicaid,” he said.


Beyond increased funding from Medicare and Medicaid, association leaders will push for action in other areas, including home care staffing.

“We really have high turnover,” Hoak said. “We always have vacancies and we’ve got to address that. Now with more people planning long-term care needs, we are in a dire situation for workers. We are not able to serve people who want to remain at home.”

Both HCAOA and Leading Age are exploring some immigration initiatives as a solution for the staffing problem. Sloan pointed to the idea of a guest-worker program for long-term care.

“Part of the workforce problem is supply,” she said. “We need to increase our supply of potential workers and convince them that careers in long-term care are valuable.”

Associations are also tuned into the issue of caregiver pay. A recent LeadingAge study pointed to the benefits of paying direct-care workers a living wage. Hoak is looking to Biden to act on his $750 billion health reform plan, which includes an initiative to improve the quality of care and increase wages for home care and other low-wage healthcare workers.

Another issue Sloan is hoping to receive support for is day care programs, many of which have had to close due to the pandemic.

“We are advocating for funding to stabilize this,” Sloan said.

Expanding the scope of practices of home care aides is another pertinent issue, Hoak said. Legislation in various states addresses topics such as medication management.

“Can we hand over a pill? In many states, we can’t touch a pill,” she said.

And two federal legislative initiatives Hoak is eyeing would permit health savings accounts to pay for home care, and allow a tax credit for family caregivers.

But as much as leaders believe there is bipartisan support for many home health and home care initiatives, solving the pandemic will be lawmakers’ first priority, Dombi said.

“If there’s a barrier to moving this platform forward, it will be that,” he said. “If we don’t solve the pandemic issues, Congress won’t play around with anything else.”