By DIANA CHEN
In an AARP survey of 2000 adults, 6 out of 10 respondents indicated they prefer to stay in their home and community for as long as possible. This desire increases with age; more than 75% of adults over 50 would rather remain in a familiar environment where they have strong connections to friends, neighbors, and businesses. However, for the elderly and people with chronic illness or disabilities, remaining at home can be difficult. These populations require services that are often provided at long term care facilities (e.g. nursing homes) and/or formal medical settings– which can be costly, inconvenient, and inefficient.
Individuals of all ages across the health spectrum have also expressed interest in receiving health services in the home or community as a means to access higher quality and convenient care. With consumer demand for patient-centered care, the U.S. healthcare system has steadily steered away from institutional services in favor of home and community-based services (HCBS). Since 2013, Medicaid expenditures for HCBS has continued to exceed spending for institutional services. HCBS now accounts for 55% of Medicaid Long Term Care spending.
As the largest payor for healthcare in the United States, the Center for Medicare and Medicaid Services (CMS), is often the first to experiment and adopt new care delivery models. With Medicaid’s perceived benefits with HCBS, the CMS has also changed what is covered under Medicare Advantage (MA) to accommodate for the transition towards home and community based care. In 2018, CMS added “non-medical in-home care” as a supplemental benefit for 2019 MA plans. This year, CMS continued to broaden the range of supplemental benefits for MA 2020 to cover any benefits “that have a reasonable expectation of improving or maintaining the health or overall function” of beneficiaries with chronic conditions or illnesses.