The Trump administration has given states three extra years to carry out plans for helping elderly and disabled people receive Medicaid services without being pushed into nursing homes.
Federal standards requiring states to find ways of delivering care to Medicaid enrollees in home and community settings will take effect in 2022 instead of 2019, the Centers for Medicare & Medicaid Services announced earlier this month. The standards date to an Obama administration rule adopted in 2014 that governs where more than 3 million Medicaid enrollees get care.
Among other things, the rule requires states to provide opportunities for enrollees to engage in community life, control their own money and seek employment in competitive settings. It also ensures that enrollees in group homes and other residential settings get more privacy and housing choices that include places where non-disabled people live.
Matt Salo, executive director of the National Association of Medicaid Directors, applauded the delay.
“We have long been on record saying that the regulation was hopelessly unrealistic in its time frame,” he said. “Delaying it actually helps consumers because the underlying regulation was going to push too many changes too fast into a system that wasn’t ready.”
In California, a lot of work is still needed to bring the state into compliance, said Eric Carlson, a directing attorney at Justice in Aging, a nonprofit advocacy organization.
“The state is going to have to pick up the pace to meet the even more relaxed deadlines,” said Carlson, who is based in Los Angeles. “Even the current timeline doesn’t give us much margin for error.”
California health officials said they appreciated the extra time. “The additional three years will allow time for the state to work with settings to come into compliance, or relocate members if compliance is not achievable,” Anthony Cava, spokesman for the state Department of Health Care Services, said in an email.
The health care services department has already developed a survey for home- and community-based providers and started working with other departments throughout the state. The department plans to begin assessing care sites by this fall — work that could last into 2019 because of the “extremely large and diverse number of settings,” Cava said.
Overall, Cava said, implementing the regulation has created unforeseen challenges. Among the biggest: funding.
“Some settings may need to make significant changes to come into compliance, but there is no additional federal funding provided for such changes,” Cava said.
The Obama administration’s 2014 rule was an effort to create a federal standard to improve the quality of care that the disabled receive outside institutions.
Some states had tried — and struggled — to make changes on their own, partly due to a lack of funding and the political difficulties of changing deeply entrenched relationships with providers.
Some, for instance, had required providers to change longstanding operations at group homes and so-called sheltered workshops, such as Goodwill Industries, where disabled people often work apart from other employees, performing menial tasks for less than minimum wage.