LeadingAge Advocacy Goals
- Secure funding to stabilize the adult day services field and make sure providers are able to sustain through and beyond the COVID-19 pandemic.
- Promote the ability of states to provide relief to safety net adult day providers through their Medicaid programs.
- Ensure that any LTSS models from the Center for Medicare and Medicaid Innovation is inclusive of all settings in the home and community (e.g., home health and personal care, adult day other day-based services, PACE services) and provide the supports (e.g., transportation) needed to facilitate these.
- Advance policy that promotes the availability of adult day services across funding streams, including Medicaid, Medicare, and Veterans Affairs (VA).
- Promote federal rulemaking and compliance with current regulations that ensures access and quality HCBS for beneficiaries while minimizing provider burden.
Home and community-based services (HCBS) providers are at an inflection point, and adult day services providers, in particular, are at risk. Over the last decade, significant improvement has been made in the availability of and public investment in these critical LTSS providers, however, the COVID-19 pandemic has put these resources at risk both at present and over the long term.
Since the start of the pandemic, many adult day centers closed either by mandate or voluntarily, and many saw most of their revenue streams evaporate overnight. Those that have since reopened have done so at reduced capacity and with fewer participants attending. This has led to centers closing across the country, jeopardizing the availability of these services over the long run. Federal funding, as well as flexibilities from payers like Medicaid and the VA, continue to be sorely needed.
Through the American Rescue Plan Act (ARPA) dollars, adult day providers have been able to access some relief in the form of funds to maintain operations, pay workforce, and rate increases. More is needed to maintain this critical sector that enables older adults to remain in their homes and communities.
ADVOCACY ACTION 2023
Click here to see the full list of Adult Day legislation LeadingAge is following in the 118th Congress.
- Supporting the community-based care workforce. We support legislative efforts to ensure that community-based care workers earn at least a living wage and have opportunities for professional development. We support efforts to increase the pool of qualified applicants domestically and internationally.
- Medicaid FMAP: We support a continuation of the 10% increase in the Federal Medical Assistance Percentage (FMAP) for Medicaid HCBS to ensure states have the funds needed to sustain these services.
- Benefit categories: We ask Congress to revise Medicaid and put HCBS (including waiver and state plan services and PACE) on equal footing with nursing homes and make HCBS a mandatory Medicaid benefit.
- Protecting access: We support making permanent key provisions that ensure access to HCBS, including the federal spousal impoverishment protections for Medicaid HCBS and the Money Follows the Person program.
- Adult Day coverage under Medicare: We believe Congress should amend the Medicare program to make adult day services available to beneficiaries.
- Appropriations: We support both increasing funding for key provisions that support HCBS, including Older Americans Act services and advocating for specific adult day appropriations to help with reopening and expansion
- HCBS Settings Rule Compliance: We will continue to work with states and CMS on HCBS settings rule compliance and advocate for changes to make compliance less burdensome for both adult day providers and those they serve.
- Telehealth: We ask CMS to encourage states to make telehealth available as a meaningful option for Medicaid HCBS providers unable to deliver in-person services.
- Protect Medicaid financing
- New models of payment and integrated care: LeadingAge will continue to engage CMMI to shape care and payment models that offer integrated care delivery and create opportunities within existing and new models for post-acute providers, housers and/or LTSS providers including adult day to play a meaningful role that ensures a share of the financial gains achieved.
- Prepare for unwinding of the PHE: work with members on the impacts of the impact of the unwinding of the Medicaid provisions tied to the public health emergency and work with CMS as needed to advocate for member needs.
- VA Coverage of Adult Day Services: We will closely monitor developments with the VA Community Care Network program and other VA initiatives that provide HCBS and advocate for our members and the veterans they support.
- Transportation and Medicaid: We support the maintenance of current rulemaking that assigns non-emergency medical transportation (NEMT) as a mandatory Medicaid benefit. We also will continue to advocate for more integration between adult day and transportation to ensure seamless access to care.
- Supplemental Services under Medicare Advantage: We will encourage CMS to continue broadening adult day services available in Medicare Advantage and work with plans on implementation.
- MACPAC: We will monitor and engage with MACPAC as needed regarding their recommendations around HCBS.
- Family caregiving: LeadingAge recognizes the critical role family caregivers play in the care of older adults in the community. We will continue to monitor and engage on the U.S. Department of Health and Human Services, Administration of Community Living’s (ACL) National Strategy to Support Family Caregivers.
ACTIONS YOU CAN TAKE NOW
- Visit the Advocacy Action Center and help your Members of Congress understand how policies they make impact Adult Day Services.
- Host a Coffee Chat with Congress in your community to help your Members of Congress understand how policies impact Adult Day providers and residents.
- Mobilize with the Advocacy Champions toolkit and let your Representatives and Senators know you support more opportunities to create and sustain home and community-based services.