Sustaining Flexibilities in Medicare and Medicaid
Federal and state governments enacted significant flexibilities during COVID-19 to ensure that Medicare and Medicaid beneficiaries could receive care in community. For example, some states allowed Medicaid to cover help at home and Medicare significantly expanded telehealth coverage.
Older adults have benefited from easier access to care in the community.
Health Management Associates and Manatt Health identify next steps for advancing person-centered, equitable care through the flexibilities.
Adaptations made through 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?
As policymakers determine the future of care, we believe that providers and payers should retain and expand upon COVID-19-era policies. These changes could support older people with complex care needs and their family caregivers, expand self-directed care models, leverage remote technologies, and provide care at home—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 and Medicaid flexibilities. This initiative helps identify what’s worked and what still needs to occur or be further adapted.
Moving Toward More Person-Centered Medicare and Medicaid Programs
The latest March 2022 research finds that many COVID-19-era flexibilities minimize administrative, clinical, and financial barriers while significantly advancing equitable care.
The issue brief examines the benefits and risks of COVID-19 flexibilities, describes a person-centered assessment framework, and offers recommendations for flexibilities that could be considered for permanence. The companion policymaker playbook is an actionable guide for using the person-centered assessment framework and describes potential authorities for making flexibilities permanent.
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, with Manatt Health, developed a person-centered framework for policymakers to assess new Medicare and Medicaid flexibilities. Tenets include: 1) advancing person- and community-centered care; 2) facilitating care in the least intensive setting; and 3) aligning program rules.
Manatt Health developed and updated the COVID-19 state resource guide, a tool for policymakers and other stakeholders to understand how states are deploying federal emergency funding and Medicaid regulatory flexibilities to improve access to LTSS for older adults and people with disabilities of all ages.
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.
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.
Leveraging Medicare-Medicaid Flexibilities to Expand Home-Based Care
This Duke-Margolis Center for Health Policy webinar discusses leveraging payment reforms to expand home-based care.
This Duke-Margolis Center for Health Policy webinar discusses leveraging payment reforms to expand home-based care.Leveraging Medicare-Medicaid Flexibilities to Expand Home-Based
In this 2021 Forum virtual session, attendees learned about the Medicare and Medicaid flexibilities enacted during the pandemic and heard from local providers who used the flexibilities to meet the medical and long-term care needs of older adults and their family caregivers. They also considered what policy actions should become permanent to achieve person-centered care in the future.Transforming Medicare and Medicaid Beyond COVID-19
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.