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.
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.