Sustaining Flexibilities in Medicare and Medicaid

Substantial regulatory flexibilities were enacted during COVID-19 and remain, meaning that care paid for by Medicare and Medicaid can be organized and delivered in novel ways. For example, nonmedical care such as help within a household is covered in some states; and in some places, telehealth visits no longer require an initial face-to-face visit and are allowed to be billed at in-person reimbursement rates.

The Challenge

Adaptations made under the auspice of the COVID-19 Public Health Emergency show that older adults can be safely cared for at home or in their immediate community. Many of these changes have a profound impact on health care delivery and can serve as the basis for person-centered care. However, these flexibilities are still temporary.

Returning to the pre-pandemic way of accessing and paying for care is not acceptable, but there are still challenges to changing traditional mechanisms. How can we make these Medicare and Medicaid flexibilities permanent, sustaining what works and continuing to improve upon care delivery to support older adults and families?

The Opportunity

As policymakers determine the future of aging, we believe that providers and payers should retain and expand upon COVID-19-era policies. This could support family caregivers, expand self-directed care models, leverage remote technologies, provide care at home, and reduce administrative barriers to care, all while still protecting Medicare, Medicaid, and dual eligible beneficiaries.

Aim and Approach

We’ve engaged with a series of independent partners to expand the knowledge base through reporting on the implementation and outcomes of the Medicare-Medicaid flexibilities. This initiative will help identify what’s worked and what still needs to occur or be further adapted.

Policy flexibilities in the Medicare program, from virtual care to meal support and in-home caregiving, confirmed the health system can work with older adults where they are, rather than forcing them into a brick-and-mortar medical facility.”

Sarita A. Mohanty
President & CEO
The SCAN Foundation

The Biden administration has inherited [a] slate of temporary COVID-related Medicare regulatory changes and will have to decide whether and how to extend these policies given the state of the pandemic and its impact on health care providers.”


Jennifer Podulka
Senior Consultant
Health Management Associates

As states consider … which flexibilities to adopt for future COVID-19 ‘waves’ and other public health emergencies, policymakers should engage care recipients, caregivers and providers to evaluate the impact of such changes.”


Stephanie Anthony
Senior Advisor
Manatt Health



Our Thought Partners

Alliance for Health Policy

The Alliance for Health Policy is disseminating research to state and federal policymakers on how Medicare and Medicaid flexibilities introduced during the COVID-19 pandemic may be leveraged to enhance quality and access to person-centered care for older adults with complex care needs.

Health Management Associates

Health Management Associates has identified and is continuing to categorize temporary federal regulatory changes to Medicare made as a result of the pandemic. They describe the benefits and risks and the possible effects on the Medicare program if the policies are made permanent.

Manatt Health

Manatt Health is documenting federal and state Medicaid flexibilities available to state officials and other stakeholders. They describe examples of how those flexibilities are being deployed to help ensure access to long-term services and supports (LTSS), such as bolstering pay and other supports for LTSS providers.

Convergence Center for Policy Resolution

Convergence Center for Policy Resolution is identifying policy and practice breakthroughs to advance structural reform among constituencies with different visions of care settings for older adults—including nursing home care, residential care, and home- and community-based services.




Duke-Margolis Center for Health Policy

The Duke-Margolis Center for Health Policy is convening and interviewing experts to generate implementation guidance and policy recommendations on payment and reimbursement strategies for expanding and sustaining delivery of home-based care over the long term.

Milken Institute

The Milken Institute Center for the Future of Aging is focusing on actionable solutions to integrate health and home care through technology. By engaging partners across sectors, including health, technology, government, philanthropy, and finance, they seek to identify and advance promising initiatives and policies to build the care ecosystem.

Lynda and Heather's Experience

2020 was an incredibly challenging year. Lynda Miller and her daughter Heather Calvin poignantly recount when Lynda came down with COVID-19. Using flexbilities made possible due to the public health emergency, hear how a home-care program team from Scripps Health supported Lynda’s transition home.

Transforming Care in the Time of COVID-19

This video was shown during our 2021 Forum: Amplifying All Voices in Aging, and part of our effort to highlight people’s experiences aging and engaging with the health care and long-term services and supports systems.