AARP Advocates to Expand Home Care

For many older Virginians who need help paying for in-home care, the initial hurdle can be daunting: a wait time as long as three months to be deemed eligible for Medicaid.

Home health agencies generally can’t wait that long to start getting paid. Nursing homes typically can. So someone who needs only light assistance, such as help cooking meals or getting dressed, can end up being forced into a long-term care facility.

“The fear is, are they ever going to be able to leave? Is that just an on-ramp into permanent institutionalization?” says Alice Burns, associate director of the health policy nonprofit KFF’s program on Medicaid and the uninsured. (Medicaid is the joint state-federal health insurance for low-income and disabled Americans.)

AARP Virginia is planning to push the General Assembly to create a fast-track process to determine Medicaid eligibility for older adults who need home or community-based care. It will be one of AARP’s main priorities when legislators convene in January, says Jared Calfee, state advocacy director for AARP Virginia.

As Virginia’s population of older adults grows, he says, it’s particularly critical to expand home care options.

“We have a long-term care system that is strained and on the cusp of breaking,” Calfee says. “We need to be looking really hard at ways to allow people ... to age in place.”

Eight other states have in place or have approved a fast-track policy—called “presumptive eligibility”—which allows patients to start getting Medicaid coverage as soon as an initial screening shows they are likely to meet the income and asset requirements (see box for details). Several other states implemented temporary or pilot programs during the COVID-19 pandemic.

“If I’m desperate and I need help, the nursing home is the only place I can go to get immediate help without policies like a fast track or a presumptive eligibility,” says Bea Rector, assistant secretary for aging and long-term support in Washington state’s Department of Social and Health Services, where the policy’s been in place since 2017.

Calfee notes that Virginia already offers a fast track for Medicaid eligibility for people needing hospitalization.

Burns says that in other states, some critics have opposed presumptive Medicaid eligibility for home care due to a fear the state would be on the hook for the cost of home care for people whose initial eligibility finding is later deemed incorrect. But in Washington state, data shows the initial eligibility decision is accurate  93 percent of the time, Rector says.

She says such programs are generally at least cost neutral, if not a cost savings, because it’s far less expensive to provide care in a person’s home or community than in a nursing home.

Simplifying a complex process

Medicare, the federal insurance program for adults 65 and over, generally covers home-care services only in certain circumstances. And paying out-of-pocket can be prohibitively expensive for many families. Medicaid covers more home and community-based services for low-income individuals.

MaryBeth Musumeci, a health policy professor at George Washington University, says Medicaid presumptive eligibility for home and community-based services is a “very positive idea.”

It simplifies a complex process, she notes, and many people who apply for Medicaid are in a health crisis, so it’s already a “confusing and stressful time.”

If Virginia enacts the policy, the state could appoint assessors, such as from the Area Agencies on Aging, to do a speedy check of whether the person is likely to qualify for Medicaid, which could help them stay out of a nursing home. A 2021 AARP survey found that 77 percent of adults 50-plus say they want to remain in their homes as they age.

An unwanted move from home into an institution can take a high emotional toll, says Wendy Fox-Grage, a senior director at the nonprofit National Academy for State Health Policy.

“Once someone goes into a nursing home ... it’s harder to then get back out,” she adds. People may lose their housing, and any savings they have could end up paying for the nursing home care, leaving them with few resources to return to their communities.

Targeting drug costs

AARP Virginia will also press the legislature to create a prescription drug affordability board, which would have the power to set payment limits for certain high-priced medications.

A bill to create such a board passed in February, but Gov. Glenn Youngkin (R) vetoed the measure. In his veto statement, Youngkin argued it could “limit access to treatments and hinder medical innovation.”

Calfee says high drug costs are a top concern for older Virginians and AARP will continue to fight for the measure. He hopes Youngkin will reconsider his position.

Tamara Lytle, a freelance writer in the Washington, D.C.,  area, covers everything from politics to parenting. She has written for the Bulletin for 15 years.

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More on Medicaid HCBS

How to apply for Medicaid:

• Individuals or families may apply for Medicaid through their local Department of Social Services.
• For a local office, visit dss.virginia.gov/localagency/index.cgi.
• You can also call Cover Virginia at 855-242-8282 or apply online at commonhelp.virginia.gov/access.

Who is eligible for Medicaid home or community-based services:

• The income limit varies depending on personal circumstances, but generally, an individual can’t earn more than $2,829 per month.
• An applicant can’t have assets over $2,000 as an individual. A person’s home is excluded from the asset total unless the equity exceeds $713,000 for 2024. (That figure is adjusted annually.)
• Typically, individuals being assessed for receiving long-term care are evaluated as a household of one. But if the person is married, their spouse and other household members’ information may be necessary to determine eligibility.

Also of interest:

• What is the Difference Between Medicare and Medicaid?
• Aging in Place: 5 Changes to Make to Your Home That Won't Break the Bank
• Smart Guide to Aging in Place