Lack of Funding Causing Low In-Home Care Benefit Adoption Among Medicare Advantage Plans

Despite a rise in the number of Medicare Advantage (MA) enrollees over the past several years, the percentage of MA plans offering supplemental benefits, including home care services, is on its way down.

That’s according to a recent study conducted by Duke University’s Margolis Center for Policy Health.

Overall, there were 22 million Medicare beneficiaries enrolled in Medicare Advantage plans in 2019, compared with 10.5 million in 2009, according to data from the Kaiser Family Foundation. San Francisco-based Kaiser Family Foundation is a nonprofit that focuses on national health issues, as well as the U.S. role in global health policy.

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After the Centers for Medicare & Medicaid Services (CMS) first expanded the scope of MA supplemental benefits in April 2018, the participation from home care providers was fairly low.

In fact, only 3% of MA plans offered in-home support services in 2019, according to AARP statistics.

Yet the tide seemed to turn, with 90% of home care providers saying they anticipate contracting with an MA plan for 2020, according to a Home Health Care News survey conducted in May.

“We are encouraged to see progress in 2020 projections for both in-home support services and support for caregivers of enrollees,” FirstLight Home Care CEO Jeff Bevis previously told HHCN. “Both will help begin to better address the potential impact and improvements from home care services in MA supplemental plans. [But] I still see major room for expansion in the future.”

About 11% of MA plans offered some sort of a supplemental benefit in 2019. For some, this meant in-home support services.

“In 2019, the largest increase was in the number of plans offering a benefit for caregiver support, with a much smaller number of plans offering palliative care, in-home support services, and non-opioid pain management, and no plans offering adult daycare,” Duke researchers wrote.

The researchers noted that for 2020, 377 MA plans will offer at least one supplemental benefit — or just 7% of all plans out there.

In general, the news falls in line with a previous study by actuarial consulting firm Milliman, which claims that at least 364 plans will provide supplemental benefits.

One of the major challenges that arise for MA plans when trying to implement supplemental benefits is a lack of new funding, according to the recent study.

“While they appreciated the new regulatory flexibility allowed by CMS, plan leaders stressed that no new funding is available for offering these benefits,” the researchers wrote. “Broadening the types of supplemental benefits allowed is, in practice, a re-programming of finite existing funds rather than an investment of new resources.”

Other notable challenges include access barriers in rural areas and difficulties contracting with community-based organizations, such as the inability of the organization to meet the liability insurance requirements.

Overall, researchers note that, in 2020, many MA plans will offer more than one supplemental benefit in comparison to 2019, when no plans offered more than one.

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