“Medicaid’s 80/20 Rule: New Restrictions on Funding for Home and Community Based Services”

“Medicaid’s 80/20 Rule: New Restrictions on Funding for Home and Community Based Services,” JD Supra

“Without an increase in rates, the 80/20 rule may have a significant negative effect on the financial feasibility of operating HCBS. Even without the additional restrictions of the 80/20 rule, the low Medicaid reimbursement rates for these services already make it challenging for many operators to make a profit. Requiring operators to spend 80% of these low rates on compensation may make it more likely that operators will choose not to participate in Medicaid, which will likely further reduce access to home-based service in rural and other underserved areas.”

LTC Comment, Stephen A. Moses, President, Center for Long-Term Care Reform:

CMS micro-management of Medicaid is choking home and community-based care availability. A free market with more private payers is the only hope to expand the sector. Ironically, unrealistic government staffing and profitability mandates may bring that to pass by eliminating competition from Medicaid financed free care.