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$1.9T Stimulus Bill Now Includes 10% Payment Boost for Home- and Community-Based Services

The $1.9 trillion stimulus package took a critical step on Saturday. It passed in the Senate, which then sent it back to the House of Representatives for final deliberation before ultimately landing on President Joe Biden’s desk.

From a home-based care perspective, one of the most noteworthy elements of the Senate passage was that the home- and community-based services (HCBS) Federal Medicaid Assistance Percentage (FMAP) payment boost was even higher than expected. Instead of a 7.35% hike to HCBS funding, the stimulus bill now includes a 10% increase.

The 10% FMAP increase means an additional $12.67 billion in funding for HCBS from April 1 of 2021 to March 31 of next year.

“I think that targeted funding towards HCBS is very positive,” Darby Anderson, vice chairman of the Partnership for Medicaid Home-Based Care (PMHC), told Home Health Care News. “There are a couple of things that I think it can help with.”

Washington, D.C.-based PMHC is an advocacy organization focused on Medicaid providers of home- and community-based care.

For one, the 10% boost will help take the place of COVID-19 relief funds that have been exhausted over the last year, such as money from the CARES Act. Over $175 billion has been doled out to health care providers through the CARES Act since last spring.

The payment bump will also help with recruitment, which has been very tough for providers during the pandemic as demand has risen, Anderson said.

“Hopefully, states can utilize that provision to continue some of those temporary rate increases — and other provisions that they’ve put in place — through the end of the pandemic,” Anderson said. “This provides a window for that. Also, recruitment has been very challenging. … Whether it be school closures or unemployment assistance, it all created a complicated decision matrix for people seeking employment in home care. So hopefully states can do something with these funds to help really shore up the workforce.”

As for unemployment benefits, bipartisan jockeying knocked the original proposal in the bill down. The add-ons were lowered in order to advance the package, from $400 per week to $300 per week, which is consistent with the current benefits from the last spending package.

The additional unemployment benefits will last through Sept. 6. While they presented a challenge to providers at the beginning of the public health emergency, the reduced add-on would put weekly benefits at just half of what they were early on in the pandemic.

The payment boost undoubtedly will help Medicaid-based home-based care providers for now, but some have raised concerns about that funding eventually ending — and what it would mean for the workforce.

“Obviously, nobody likes to go back and say, ‘Here is a reduction in your pay,’ but I think people do understand the temporary nature of the pandemic and COVID hazard pay,” Anderson said. “So that should be a little easier. But I do think states need to be careful in terms of what they use the money for. [They need to] avoid that cliff facing them in spring of 2022 when the funding goes away.”

In addition to the rate hike, the stimulus bill would provide $350 billion for states, local governments, territories and tribal governments to help with budget crises facing all levels of government.

That will also be helpful for states that were facing tough decisions on cuts to Medicaid and Medicare, for example.

“I just hope states understand and think about … what we need to do to enhance or shore up home- and community-based services with this opportunity, and not just try to just do something in a vacuum,” Anderson said. “Because I think it’s complicated. And I don’t really want to see them undertake efforts that do something short term and then, next April, it leaves a giant hole and in a budget or something.”

As for extra funding for providers in general, Sen. Susan Collins (R-Maine) suggested an amendment to the bill to provide $35 billion more in funding to “health care providers for health care related expenses and lost revenues attributed to COVID-19.”

That relief would include assisted living and senior congregate home providers as eligible recipients.

But other advocacy organizations such as the American Hospital Association (AHA) are still disappointed with the lack of additional COVID-19-related funding in the bill as it stands now.

“The AHA is disappointed that the bill does not deliver more overall funding for the Provider Relief Fund, which has been crucial in supplying hospitals, health systems and other providers with resources during the pandemic,” Rick Pollack, AHA president and CEO, said in a statement. “We are also concerned that this bill does not include an extension of relief from Medicare sequester cuts, which will go back into effect at the beginning of next month, and also fails to provide loan forgiveness for Medicare accelerated payments for hospitals.”

This article was written by Andrew Donlan March 8th, 2021 and can be found here. Please be sure to visit for more articles by Andrew and other quality contributors.