July Legislative Session Revisits MRT Limits on Home Care, with Far More Work Needed 

Last week, the Legislature advanced bills designed to mitigate some prior-instituted limits on home care eligibility and access.

Yet, more work needs to be done at a time when the public increasingly looks to home care as a safe and preferred option for long term care — especially in the context of a global pandemic where home care is naturally suited to provide supports in distanced community settings.

MRT Measures Revisited

The original home care policies sprang in unprecedented fashion — on the upswing of the COVID-19 health emergency — with the passage of Medicaid Redesign Team (MRT) recommendations in the April state budget.

Among them is a “look-back” period, instituting a penalty of home care ineligibility for Medicaid home care applicants who made certain asset transfers within the past two-and-a-half years.

During the just-completed July session, Senator Gustavo Rivera (S.8337) and Assemblyman Richard Gottfried (A.10489) sponsored legislation clarifying that this look-back period for home care would only apply to transfers occurring after October 2020, when the look-back policy is set to go into effect. The bill also lists conditions that lessen the resulting penalty period (such as if the transferred funds had been used for the care of the patient), and it enables home care to be provided under immediate need through attestation. The Senate version of this bill passed on July 22.

Another measure, S.8403 (Rivera)/A.10486 (Gottfried), eases the higher threshold placed by the MRT on eligibility for Medicaid personal care services for people with traumatic brain injury (TBI), intellectual and developmental disabilities (IDD), cognitive or visual impairment. (In such cases, the MRT language deems that individuals must have an additional diagnosis of limitations in more than two “activities of daily living.”) The new bill makes eligibility equivalent to individuals with dementia/Alzheimer’s Disease and who are assessed to need supervision/oversight plus more than one activity of daily living. It passed the Senate on July 22.

Opportunity for Further Scrutiny of MRT Actions 

The bills above await action by the Assembly. HCA asks the Legislature to use this opportunity to further scrutinize several other adverse measures swiftly adopted during the state budget earlier this year on the basis of MRT recommendations.

These MRT actions cut home care delivered and overseen by providers, managed long term care plans (MLTCs) and Consumer Directed Assistance Programs at precisely the time when such services are in increased demand, and especially in the COVID-19 pandemic.

Yet another MRT action, for instance, requires a separate state contractor to assess patients for home care, taking this function out of the professional hands of nurses and care managers who are ultimately charged with this care. This measure needs serious reworking, including a decision-making role for providers and MLTC plans that have more immediate knowledge of patients’ needs, care planning and outcomes.

Increasingly, individuals need care at home. These needs are of a higher complexity and intensity as individuals seek to stay out of skilled nursing facilities and other congregate care settings wherever possible.

The pandemic has forced us to reexamine all areas of policymaking. Through this lens we can see clearly the direction our service delivery system needs to go in — and that signs were pointing in this direction long before, though the message is now more pronounced.

HCA urges the Legislature to continue revisiting faulty aspects of the MRT package before the adverse effects hit the system, and ultimately, the patients.