2 More Ways Trumpcare Impacts Home Health

With the Republican health care plan awaiting its day for a vote, home health care providers are determining how the bill will impact Americans—and their businesses.

The biggest outcry from the home health care industry has been about the significant cuts to the Medicaid program, estimated to be more than $800 billion in the House version of the plan and more than $770 billion in the Senate version. Both versions of the health care plan would fundamentally change the way Medicaid is funded, providing states a choice between per capita caps—a funding cap per enrollee with a pre-set growth rate—or a lump-sum block grant.

Fundamental changes to Medicaid financing have little to do with the Affordable Care Act (ACA)—the law that Republicans staked their 2016 campaign promises on. However, there are some signifiant rollbacks in ACA, or Obamacare, regulations within the Republican health care plan.


Here are two Obamacare provisions that could be eliminated under a new health care law that will impact the home health care industry:

1. Elimination of employer mandate

One of the most cheer-worthy provisions in both the House and Senate versions of the health care legislation is a repeal of the employer mandate, an ACA-era regulation that requires qualified businesses to offer health insurance options for full-time employees.


The mandate had a major impact across many small and independent businesses with 50 or more full-time employees, and hit providers that offer Medicaid in-home care services particularly hard, Bill Dombi, vice president of law at the National Association for Home Care & Hospice (NAHC), told Home Health Care News.

“When the ACA was passed, that’s where our focus went on day one,” Dombi said of the employer mandate. “Home care companies took a variety of steps to avoid a penalty.”

Some of these steps included limiting the number of employees to remain under the 50 full-time employee threshold, as well as limiting hours to under 30 hours per week to keep employees just under full-time statusaccording to Dombi.

The mandate hit Medicaid providers hardest. Due to the low margins of operation and low reimbursement rates, many companies couldn’t afford the additional cost of providing health insurance to their employees.

Agencies “celebrated” when the coverage penalties were first delayed and then phased in, Dombi said.

Without the mandate, Medicaid in-home care providers will see a positive change in the cost of running their businesses, industry stakeholders agree.

2. Elimination of the Community First Choice program

Another significant impact of the legislation is that it would eliminate a the Community First Choice federal program, which provides additional Medicaid funding for in-home care providers in some states. 

“It’s a program that provides additional federal support to rebalance Medicaid spending toward home- and community-based services (HCBS),” Dombi said. “It’s a 6% federal match.”

Only eight states—California, Connecticut, Maryland, Montana, New York, Oregon, Texas and Washington—have approved plans for the program, which allows states to provide home and community-based attendant services and supports to Medicaid beneficiaries.

And the overall cost impact of the program is significant. When the program first rolled out, the Congressional Budget Office (CBO) revealed it would cost $13 billion over time. Now, the cost is even higher.

“The CBO scored it as a $19 billion reduction in Medicaid support,” Dombi said. “That’s a $19 billion reduction for home care.”

Other industry groups have voiced their concern over the potential loss of this program, which helps keep eligible beneficiaries out of higher-cost care settings.

“The [proposed Republican] bill eliminates funding for personal care assistants through Medicaid, which would significantly reduce access for seniors and people with disabilities,” Joy Cameron, vice president of policy and innovation at ElevatingHome, told Home Health Care News.

The Community First Choice program has been a bright spot among Obamacare provisions that impacted in-home care services because it came with billions in extra funding.

“When the Affordable Care Act was passed, there was a lot of bad news for home care, but the Community First Choice aspect was good news at that point in time,” Dombi said. “Now, it’s valued at $19 billion over ten years being taken away.”

Senate Republicans postponed a vote on the health care bill, which was originally planned to occur before the July 4 holiday. Sen. Majority Leader Mitch McConnell postponed the vote because Republicans did not have the required simple majority of 50 votes—plus a tie-breaker affirmative vote from Vice President Mike Pence. The bill is expected to undergo changes over the next few weeks to appease Senators who are on the fence over their vote.

Written by Amy Baxter

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