Survey Highlights Home Care Reductions in Senate Health Bill

Mass Home Care recently released a survey of the projected financial loss elders in Massachusetts will face if a Senate health plan to “transfer funds” from home care into another managed care plan.

Under Section 143A of the Senate health care affordability act (S. 2202). a total of 5,581 elders on MassHealth Standard would be disenrolled from the managed capitation home care program, and passively enrolled into the managed capitation Senior Care Organization (SCO) program. The home care program could then lose as much as $20.8 million on an annual basis due to these automatic disenrollments. This represents for elders the largest loss of funding in a single year in the home care program since it was created in 1973.

The survey also shows the potential financial impact on elderly consumers who apply for home care services from the 26 non-profit Aging Services Access Points (ASAPs). The home care program will be impacted in two ways:

  1. When an elder is disenrolled from home care, the ASAP serving that person loses $310.76 per month ($3,729.12 annually) in home care services, and $137.74 per month ($1,652.88 annually) for care management services. The ASAP thus stops billing for services and care management totaling $5,382 per member per year. [Note: some of these disenrolled clients will still be managed by ASAPs, because they will be determined to be in need of “complex care” supports from the SCO program they have been enrolled in passively. ASAPs are on care team of SCOs–but only if the elder has complex care needs. Funding for both home care services and care management may not remain at the same level as when the elder was in home care.]
  2. More significantly, Section 143A requires that in addition to the end of the home care capitation for elders disenrolled, the home care appropriation in line item 9110-1630 will be reduced due to “transfer of funds” language. This second level of loss reduces the capacity of the home care program to serve elders who are not eligible for Medicaid. The loss of an estimated 5,581 members in the home care program will result in the home care appropriation losing $20.8 million per year.

The survey indicates that 241 elders in the Somerville-Cambridge Elder Services (SCES) service area could be passively enrolled, costing the program $898,717.92.

The “transfer of funds” between programs has never been done before in Massachusetts. If funds had been transferred from the nursing facilities appropriation to home care every time an elder was disenrolled from a nursing facility, the home care program would have seen a funding increase of hundreds of million dollars.

Nursing facility patient days paid for by MassHealth have fallen 37% between the years 2000 and 2016. The total MassHealth nursing facility patient days in 2016 were 4.85 million lower than in 2000, saving state and federal taxpayers a combined total of more than $1 billion in 2016 alone. None of that money was transferred to the ASAP system.

A loss of 5,581 slots in the home care appropriation means 5,581 elders not on MassHealth may be unable to get into home care. The Senate language suggests that a waiting list would not be allowed to happen, but additional funds would need to be appropriated to keep home care open for elders just over the MassHealth income and asset eligibility level.

As of Dec. 5, the “transfer of funds language was not approved yet by the House.

SOURCE: Mass Home Care 

Mass Home Care represents a statewide network of non-profit agencies that offer community-based supports for older adults, their caregivers and families. Somerville-Cambridge Elder Services is part of that network, and serves as the ASAP for Somerville and Cambridge

Somerville-Cambridge Elder Services (SCES) is a non-profit agency that supports the independence and well-being of older people in Somerville and Cambridge. For more information, visit, follow us on Facebook and Twitter, or contact the SCES Aging Information Center at 617-628-2601 for free advice and guidance.