Humana thanks the Virginia Department of Medical Assistance Services (DMAS) for the opportunity to provide suggestions for the use of increased home and community-based services (HCBS) funding available under the American Rescue Plan Act (ARPA). Humana is a longtime partner of the Commonwealth, currently serving more than 980,000 Medicare, commercial, and Tricare members. Through their community and provider relationships, infrastructure, and data capabilities, we believe that managed care organizations (MCO) are well positioned to be strong partners of the Commonwealth in the implementation of the enhanced HCBS funding. In addition to providing coverage of HCBS services, MCOs forge partnerships and operate programming aimed at supporting members receiving HCBS services and their caregivers and addressing social needs like social isolation. Programmatic recommendations you may want to consider are as follows:
Recommendation 1: Promoting Access to Waiver Services
Humana supports the use of enhanced HCBS funding to shorten the waitlist for the Developmental Disabilities waivers, particularly for those members who are deemed to have Priority Level One Needs. In addition, we encourage DMAS to consider expanding waiver eligibility to allow more members to benefit from waiver services.
We also support the use of federal medical assistance percentage (FMAP) funding to provide short-term services that can provide a bridge until members on the waitlist can receive waiver services. For example, members and their caregivers may benefit from receiving training on seeking employment, expanded transportation to access employment and community services, and enhanced supports for transitions from institutional settings into the community. MCOs can assist in arranging and providing those bridge services that fall within the scope of managed care services.
Recommendation 2: Support Workforce Development and Increase Reimbursement Rates
The National Center for Health Workforce Analysis estimates that from 2015 to 2030, the need for more direct care workers may increase by 48%.[i] The enhanced HCBS funding made available under ARPA creates an opportunity for DMAS to address workforce shortages and the increased demand for direct care workers. Humana supports the use of increased funding on activities designed to build and retain this essential workforce. These activities include, but are not limited to:
Recommendation 3: Reconnecting Members to Essential Supports and Services
Social isolation, exacerbated by the COVID-19 public health emergency, has a profound impact on the health and well-being of HCBS members, particularly those without access to adult day care and those who live at home. Through our enterprise population health strategy, Bold Goal, Humana has contributed to national research on the effects of social isolation on overall health and quality of life and implemented various initiatives in our Bold Goal communities across the country to measurably reduce the impact of social isolation among our memberships. Based on this experience, Humana supports DMAS’ efforts to reduce social isolation among HCBS members and reconnect them to essential services and supports. We suggest that DMAS explore the following use of the available HCBS funding:
[i] https://files.kff.org/attachment/Report-A-View-from-the-States-Key-Medicaid-Policy-Changes
[ii] https://budget.lis.virginia.gov/amendment/2021/1/HB1800/Introduced/MR/313/8h/
[iii] https://www.nashp.org/wp-content/uploads/2021/04/paying-family-caregivers-April2021.pdf
[v]https://www.dhp.virginia.gov/PublicResources/HealthcareWorkforceDataCenter/AbouttheCenter/AdvisoryCommittees/