Argentum submitted a comment letter last Monday in response to a proposed rule issued in May by the Centers for Medicare & Medicaid Services (CMS), intended to increase transparency and accountability, standardize data and monitoring, and create opportunities for states to promote active beneficiary engagement to improve access to care, including in home and community-based services (HCBS) programs.
We recommended that CMS withdraw the proposed rule and instead work with stakeholders to identify other approaches, particularly by addressing the inadequacy of state Medicaid reimbursement rates for assisted living and similar residential communities participating in HCBS programs.
In our comments, we noted that while we are supportive of the broader goals to improve access to care, including addressing the shortage of direct care workers, we are concerned that CMS’s proposal to require that 80% of state payment for certain HCBS be allocated to compensation for direct care workers is not the right approach to address these workforce shortages or increase access to services for Medicaid beneficiaries. As proposed, it is ambiguous whether this policy would apply to assisted living or similar residential facilities that provide HCBS under state Medicaid programs.
Additionally, we expressed concern that without also addressing inadequate reimbursement rates, the proposal to only allow providers 20% of Medicaid payments to address all other expenses will make it very difficult, if not impossible, for these communities to continue current Medicaid operations. This could force communities to either reduce HCBS services they are currently providing, or cease participation in the Medicaid program altogether, which ultimately would have a negative impact on direct care workforce participation and Medicaid beneficiary access to care.
Argentum State Partners contributed to the development of these comments.