Across the country, nearly 75% of individuals receiving Medicaid-funded Long-Term Services and Supports are dually eligible for Medicare (“Duals with LTSS need”). In New York State, this figure rises to almost 85% of LTSS recipients. The dually eligible population with LTSS need often encounters fragmented care that results in poor health outcomes due to inadequate coordination between Medicare and Medicaid. The Coalition for Excellence is committed to advocating for state and federal initiatives that support integrating home- and community-based services (HCBS) into the broader healthcare system at no additional cost.

Although managed long-term services and supports (MLTSS) plans receive capitated payments for Medicaid-funded long-term care, they often treat homecare as a commodity, compensating licensed agencies on a fee-for-service (FFS) basis and failing to recognize their potential to add value. By developing value-based payment arrangements, payments between plans and homecare agencies have significant potential to improve quality and drive accountability.

A rigid regulatory framework for care at home at both state and federal levels should not restrict the ability to collaboratively source innovative service delivery ideas. It is essential to further explore opportunities that promote new models and technologies to ensure that the homecare sector does not lag behind in its ability to integrate HCBS into the broader care continuum.