Medicare and Medicaid

Part of LeadingAge's 2020 Policy Priorities

LeadingAge Advocacy Goals

  • Advocate for the availability of aging services across the continuum in Medicare and Medicaid.
  • Ensure that regulations governing the Medicare and Medicaid programs promote high-quality care and are not burdensome to providers.
  • Oppose block grant and per capita cap policies in Medicaid.
  • Ensure that state Medicaid rates paid to nursing homes are sufficient to cover the costs of care.
  • Ensure appropriate reimbursement to provide quality end-of-life care.
  • Advance policy that promotes the availability of HCBS across funding streams, including Medicare and Medicaid.
  • Advance managed care arrangements, reimbursement, and operational policies that enable aging services providers to meet their mission of serving older adults.

The Issue

Whether it’s post-acute care stays in nursing homes or long-term attendance at adult day services, Medicare and Medicaid are critically important to the provision of aging services. Providers participating in Medicare must comply with annual federal regulation- including those for nursing homes, hospice, and home health. These rules can often have the effect of being overly burdensome and get in the way of high-quality care. Medicaid rates are often lower compared to what Medicare will pay for a given service. For people enrolled in Medicaid, this can result in limited or no access to the services they need.

Advocacy Action 2020

116th Congress

  • Reinstate CNA Training Programs within SNFs: We support Nursing Home Workforce Quality Act (H.R. 4468) and Ensuring Seniors’ Access to Quality Care Act (S. 2993) that would allow reinstatement of a nurse aide training program once a nursing home has been determined by CMS to be in substantial compliance
  • Observation Stays: We support the Improving Access to Medicare Coverage Act (S. 753; H.R. 1682) that would mandate all time spent in a hospital, regardless of admission status, would count toward the 3-day qualifying stay required for skilled nursing facility services under the Medicare A benefit.
  • Value-Based Payment: We support the Beneficiary Education Tools, Telehealth, and Extenders Reauthorization Act of 2019 (H.R. 3417) that would authorize the development of additional quality measures for the SNF Value-Based Purchasing (VBP) program.
  • Home Health Reimbursement: We support the Home Health Payment Innovation Act (S.433/ H.R.2573) to eliminate behavior assumption adjustments in the Patient-Driven Groupings Model.”
  • Medicare Home Health Prescribers: We support the Home Health Care Planning and Improvement Act (S.296/ H.R.2150) to expand those who can order Medicare home health services to include nurse practitioners, clinical nurse specialists, certified nurse-midwives, and physician assistants.
  • Spousal Impoverishment Protections for Medicaid HCBS: We support the Protecting Married Seniors from Impoverishment Act which expands permanently the spousal impoverishment protections authorized in section 2404 of the Affordable Care Act and is set to expire on Dec.31, 2019.
  • Adult Day Coverage Under Medicare: We support the Medicare Adult Day Services Act (H.R. 4063) that amends Medicare to cover adult day services.
  • Medicaid Rates: We will continue to work with state partners and members to ensure that state Medicaid rates paid to aging services providers are sufficient to cover the costs of care.

Executive Branch

  • Rules, Guidance, Other Federal Policy Documents. We will work with CMS on Medicaid and Medicare rules and guidance documents relevant to providers across the continuum- nursing homes, PACE, home health, hospice, HCBS waiver services.

Actions You Can Take Now

  • Visit the Advocacy Action Center to let your representative and senators know that you support the expansion and preservation of home and community-based services for older adults.
  • Host a Coffee Chat with Congress in your community to help your members of Congress understand how policies impact HCBS providers and residents.
  • Mobilize with the Advocacy Champions toolkit and let your representatives and senators know you support more opportunities to create and sustain HCBS.

Additional Resources

Source: CMS LTSS Expenditure Report