The Challenge

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?

The Opportunity

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.

Some of the temporary flexibilities granted during the pandemic sparked the most innovation in Medicare and Medicaid seen in decades. … Enhancements to these two major government programs have the potential to advance equitable, person-centered, and community-focused care now and in the future.”

Sarita A. Mohanty
President and CEO
The SCAN Foundation

There are many COVID-19-related flexibilities related to telehealth, provider scope of practice, Medicare Advantage, and other areas that if made permanent, could make Medicare a more person-centered and equitable program.” 

 

 

 

 

Jennifer Podulka
Principal
Health Management Associates

Developing a person-centered framework to guide policymakers as they assess the impact of the temporary Medicare and Medicaid flexibilities has never been more important, particularly for the over 12 million people who are enrolled in both programs…”

 

 

 

 

Stephanie Anthony
Senior Advisor
Manatt Health

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 and 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
Principal
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, 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

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.

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.

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.

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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.