Average Home Health Medicaid Rate Increased in 2015

The average Medicaid reimbursement rates for home health and personal care providers ticked up slightly last year, newly released data show.

Home health agencies received $93.93 per home health visit on average in 2015, up from $92.69 the year before, according to information compiled by the Kaiser Family Foundation. In states that paid registered nurses directly, the average rate per visit was $87.26 in 2015. For home health aides, the average rate was $52.19 per visit.

Within personal care services Medicaid plans, the average rate for providers in 2015 was $18.82 an hour. That was a slight increase from $18.73 a year prior.

Variations existed among states, of course. New Mexico home health agencies received $331.57 per visit in 2015, for example, while those in Wyoming received $52.

For personal care providers, reimbursement in North Dakota was on the high end at $19.76 per hour, while Nebraska came in at $8.68 an hour.

State legislatures often set these payment rates as part of the budget process, the report notes. The reimbursement data was gathered through surveys conducted by the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured (KCMU) and researchers at the University of California, San Francisco (UCSF).

These surveys have been tracking the growth in the three primary Medicaid programs providing home- and community-based services: home health services state plan benefit, the personal care services state plan benefit, and services under  § 1915 (c) HCBS waivers.

Participation in these three programs declined by 6% between 2012 and 2013, according to the latest report, released Tuesday. This was the largest decline in the study period, and it may be due to increasing home- and community-based care being offered through other plans and waivers, the report states.

Even as participation declined, expenditures for these three programs increased slightly between 2012 and 2013, from $55 billion to $56.5 billion.

And 2013 also marked a watershed moment in the continued expansion of Medicaid-supported HCBS.

“As states continue to implement various aspects of the Affordable Care Act (ACA), developing and expanding home and community-based alternatives to institutional care remains a priority for many state Medicaid programs,” the executive summary states. “2013 marked the first time that home and community-based services (HCBS) accounted for a majority (51%) of national Medicaid long-term services and supports (LTSS) spending, increasing from 18% in 1995.”

Minimum Wage Spurs Changes

While 2013 was the most recent year for which the report authors could collect usage and expenditure data, they gathered more current information on how states are responding to the new extension of minimum wage protections to home care workers.

In situations where a Medicaid beneficiary directs his or her own care, home care workers may be considered to be jointly employed by that beneficiary as well as the state or another entity. State Medicaid programs therefore need to meet the new mandates to pay the workers minimum wage, and need to adjust budgets or policies accordingly.

Last year, 11 waivers in seven states planned to control caregiver hours, such as Maine setting a 40 hours per week limit. The other six states were California, Kentucky, Maryland, New Mexico, Oregon and Washington. Cost or service caps on § 1915 (c) services were being implemented under 12 waivers in six states—Louisiana, New Mexico, New York, Oregon, Texas, and Washington.

Waivers in certain states also showed state funds budgeted for worker overtime pay (California, Connecticut, Kentucky, Oregon, Pennsylvania, South Carolina, Washington) or travel time pay (California, Connecticut, Oregon, South Carolina, and Washington) in fiscal year 2016.

Written by Tim Mullaney