Medicare Advantage (MA) will continue to grow significantly and offer flexibility, but the Biden administration likely will be scrutinizing plans more carefully, according to two highly respected healthcare consultants.

“This administration will not allow a blank check to MA plans,” said Dan Mendelson, the founder and former CEO of Avalere Health, who spoke during a webinar Wednesday hosted by the National Investment Center for Seniors Housing and Care. Anne Tumlinson, founder and CEO of ATI Advisory, also provided insights during “Policy Outlook: A New Administration and a New Congress.” Moderating the webinar were Lynne Katzmann, president and CEO of Juniper Communities; and Bob Kramer, co-founder and strategic adviser of NIC and president of Nexus Insights.

Mendelson pointed out that the new administration in reviewing the plans will consider the beneficiary experience, quality, and be stricter about MA marketing claims. “I think there will be a return back to a heavier level of scrutiny,” Mendelson said.

Tumlinson agreed.

“I don’t see federal rules loosening beyond what they already are, and I think CMS [Centers for Medicare & Medicaid Services] is going to watch [the programs] closely,” she said, noting that the administration may turn a watchful eye toward staff licensure issues in the area of home health.  

Flexibilities provided by MA plans will remain, Mendelson said. These include food delivery, such as for those recovering from surgery; transportation to the hospital; and pest control to eliminate environmental causes of ailments such as asthma.

“Those flexibilities are here to stay,” he said. “They have become an essential public health lifeline for many seniors in this country.”

Medicaid policy in HCBS

Also under discussion Wednesday was upcoming Medicaid policy in the area of home- and community-based services. Tumlinson said she does not anticipate CMS will pay an individual entitlement for HCBS. But if the federal minimum wage increases, she anticipates an increase in the federal matching rate to help offset labor costs. Also, the administration may increase the personal needs allowance to remove the institutional bias that allows Medicaid to pay for room and board in skilled nursing facilities but not in HCBS settings.

“If the administration and Congress are serious about removing institutional bias, creating better access to home and community-based services and increasing demand for direct care workers, they will have to address the adequacy of the personal needs allowance,” Tumlinson said in an email following the webinar.

COVID-19 vaccine, minimum wage

Other issues discussed during the webinar included Biden’s bold vaccination plan and the minimum wage. Mendelson said the administration is securing an extra 200 million doses of the vaccine.

“There will be enough vaccine likely to vaccinate everyone in this country by the end of the summer,” he said.

In the area of vaccinations, Tumlinson said the administration will try to “underpromise and overdeliver.”

Mendelson said he predicts that the minimum wage will rise modestly.

“I don’t think it’s realistic to see a $15 minimum wage in the near future,” he said.