Financing HCBS

The National Institute on Aging (NIA) has released a resource offering insights and guidance on legal and financial planning for people living with Alzheimer's disease or related dementias. This article emphasizes the importance of early preparation and covers essential legal and financial planning documents, including advance health care directives and directives for financial and estate management. This resource offers guidance on seeking assistance with legal and financial planning, including advice on advance care planning discussions with healthcare providers and locating support from elder law attorneys. Additionally, it provides information about available resources for low-income families.

On June 26th, CMS issued a proposed rule that proposes to update payment rates and policies and includes requests for information under the end-stage renal disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to Medicare beneficiaries on or after January 1, 2024. For calendar year 2024, CMS is proposing to increase the ESRD PPS base rate to $269.99, increasing total payments to ESRD facilities by approximately 1.6 percent totaling $6.4 billion. The CY 2024 ESRD PPS proposed rule also includes several proposals and requests for information related to ESRD PPS payment policies. This rule also proposes an update to the Acute Kidney Injury dialysis payment rate for renal dialysis services furnished by ESRD...

On Wednesday, March 15, 2023, MACPAC released it's March 2023 Report to Congress on Medicaid and CHIP. The report recommends a series of measures aimed at improving the collection of race and ethnicity data, increasing transparency in nursing facility payment data, and giving states greater flexibility in following Medicare drug coverage decisions. It also includers MACPAC's annual, statutorily required report examining payment policy for safety net hospitals.

On March 1, 2023 KFF released a brief titled “FAQs on Health Spending, the Federal Budget, and Budget Enforcement Tools”. The brief reviews basic questions about health spending and the federal budget and budget enforcement tools, including the debt limit and sequestration. As discussions on the federal deficit and debt continue, the KFF resource provides an explanation of federal spending for domestic and global health programs and services.

On Tuesday, February 28th, CMS released the latest enrollment figures for Medicare, Medicaid, and CHIP. As of November 2022, over 65.3 million people are enrolled in Medicare; more than 35.1 million are enrolled in fee-for-service Medicare and over 30.2 have a Medicare Advantage plan. Over 91.7 million enrollees have Medicaid and CHIP; more than 84.8 million individuals have Medicaid and over 6.9 million have coverage through CHIP. Over 12 million individuals are dually eligible for Medicare and Medicaid and are counted in the enrollment figures for both programs.

Yesterday the Centers for Medicare & Medicaid Services (CMS) announced next steps describing how the agency will implement the new Medicare Prescription Drug Inflation Rebate Program, including a timeline of key dates. As part of the Inflation Reduction Act (IRA) of 2022 (P.L. 117-169), the Medicare Prescription Drug Inflation Rebate Program requires drug companies to pay a rebate to Medicare if they raise prices for certain drugs faster than the rate of inflation. Based on a 12 month period starting October 1, 2022, drug companies will be required to pay rebates to Medicare for raising prices that outpace inflation on certain Part D drugs.

The U.S. Department of Health and Human Services, through CMS, awarded approximately $25 million in planning grants to five new states and territories to expand access to home and community-based services through Medicaid’s Money Follows the Person (MFP) demonstration program. With these awards, 41 states and territories across the country will now participate in MFP. Awards of up to $5 million have been granted to Illinois, Kansas, and New Hampshire, as well as for American Samoa and Puerto Rico. This is the first time MFP grants have been made available to territories. These awards will support the early planning phase for their MFP programs.

CMS has announced it will offer more than $110 million to expand access to home and community-based services (HCBS) through Medicaid’s Money Follows the Person (MFP) program. The new Notice of Funding Opportunity (NOFO) makes individual awards of up to $5 million available for more than 20 states and territories not currently participating in MFP. These funds will support initial planning and implementation to get the state/territory programs off the ground, which would ensure more people with Medicaid can receive high-quality, cost-effective, person-centered services in a setting they choose.

This brief shares data on state policy choices about Medicaid HCBS, including target populations, functional eligibility criteria, financial eligibility criteria, waiver waiting lists, benefit packages, out-of-pocket costs, use of capitated managed care, self-direction opportunities, covered provider types, electronic visit verification systems, and provider reimbursement rates.

The brief from the KKF shares state-level data on HCBS spending and the number of people receiving Medicaid in FY 2020. The data were collected in KFF’s 19th survey of state officials administering Medicaid HCBS programs in all 50 states and DC.