Vice President Kamala Harris took to national television Tuesday to propose a new Medicare at Home plan that would allow Medicare to cover in-home health care for seniors and individuals with disabilities.
While the Biden administration has frequently promoted home- and community-based services as an alternative to skilled nursing facilities, Harris’ proposal is the first to position Medicare as the payer for long-term use of at-home services.
Katie Smith Sloan, president and CEO at LeadingAge, sees pros on both sides of the coin.
“Today’s announcement is truly exciting and unique,” she told McKnights Long-Term Care News in a statement. “Adding home care to the Medicare program, a much needed component of a broader long-term care financing reform effort, will offer millions of older adults and families access to services that promote quality of life and safety as people age at home. At the same time, we cannot overstate that without staff, there is no care. Continued attention and investment in the workforce…remains essential.”
While some experts said the policy could be good for overall LTC delivery, others raised concerns about balancing spending on another porgram with limited Medicare dollars.
“It’s important for policymakers to evaluate how broadening Medicare’s benefits to cover home healthcare would impact the long-term care landscape overall and make evidence-based policy decisions based on these evaluations,” Allison Buffett, senior policy analyst at the Bipartisan Policy Center, told McKnights Long-Term Care News. “Older adults, in consultation with their families and providers, should have the ability to choose the care setting that works best for them. The most appropriate care setting depends on the individual and ensuring access to this setting is important for optimizing health outcomes and costs.”
Harris told hosts of “The View” television show, where she revealed the proposal, that the biggest driver behind the initiative is alleviating financial burden for the “sandwich generation.” The presidential candidate also mentioned the high costs often associated with long-term care for seniors.
“There are so many people in our country who are right in the middle,” she said. “They’re taking care of their kids, and they’re taking care of their aging parents. We’re finding that so many are then having to leave their job, which means losing a source of income. Not to mention the emotional stress.”
While details on the proposal were still sparse, Clif Porter, senior vice president of government relations and incoming president and CEO of the American Health Care Association, said not even the best proposals would succeed without funding and adequate staffing.
“We are supportive of finding ways to make long-term care and senior living more affordable and accessible for all Americans,” he said. “Seniors who require these services should be able to access the setting of their choice as well as the most appropriate setting for their needs.
“At the end of the day, the most critical aspect is investing in the healthcare workforce. The growing caregiver shortage is a looming crisis for our nation’s seniors. Without proper resources and policies to help develop more nurses, nurse aides, CNAs, and other caregivers, we simply won’t be able to meet the demands of our aging nation — regardless of the setting in which they need the care.”
He encouraged leaders in Washington to support workforce development and protect seniors’ access to high-quality care across the continuum.
A fact sheet released Tuesday afternoon following Harris’ TV appearance said the plan calls for a Medicare-private sector collaboration.
“This initiative will draw upon best practices across Medicare plans as well as the private sector to expand the home care workforce, partner with technology companies in areas such as remote patient monitoring and telehealth services, as well as other private sector partnerships,” it explained.
The backgrounder also noted that seniors would first be evaluated by a medical professional before a care provider is dispatched: “Aides will be designated by Medicare and can include any qualified home health aides, personal care attendants, or direct care workers recognized by their state.”
Funding for the new proposal would come from savings on Medicare pharmaceutical purchases, Harris said.
“Part of what I intend to do is allow Medicare to continue to negotiate drug prices with pharmaceutical companies, which means we are going to save Medicare the money,” she said.
When asked if the plan would extend to individuals with private insurance, Harris emphasized the target demographic.
“This is about Medicare,” she affirmed. “Otherwise, people have to spend down everything to be eligible for the care they need as a Medicaid recipient. That can coexist with insurance.”
