Navigating long-term care is never easy. Recent changes in Medicaid rules demand your attention. The latest Medicaid rule, also known as the "80/20 rule," aims to improve access to care and transparency. Some believe that controversial new regulations could decrease access to care. Here’s what families and seniors need to know.

What Is the 80/20 Medicaid Rule?

The Centers for Medicare and Medicaid Services (CMS) released a landmark rule on April 22, 2024, the "Ensuring Access to Medicaid Services Final Rule." It sets new standards for payments, care quality and transparency. The most controversial provision is the 80% compensation pass-through requirement for direct care workers.

How Does the 80/20 Rule Work?

The 80/20 rule mandates that providers pass on 80% of Medicaid rates to direct care workers for three specific services:

• Homemaker Services
• Home Health Aide Services
• Personal Care Services

The rule strengthens person-centered service planning by providing annual functional assessments to 90% of Medicaid enrollees. States must now use advisory groups that include Medicaid participants when developing rates. Providers must also publish rates, report cost structures and disclose percentages for bundled services. While this is a positive change, it requires extra resources to implement.

Although the rule intends to improve care access and quality, many providers may struggle to comply with the 80/20 rule due to financial constraints. According to LeadingAge, this could reduce the number of Medicaid providers available to seniors and increase prices.

Providers must report compliance with the 80/20 rule at the individual provider level rather than at the state level. This means more paperwork and potential penalties for non-compliance. This could ultimately decrease access to care, which is contrary to the goal of the new Medicaid rule.

What Strategies Can Families Use to Navigate the New Medicaid Rules?

Families can take strategic steps to accommodate any increase in cost or loss of coverage related to the new rules.

Understand the New Rules

Medicaid is already complex and full of rules that can be hard to follow. Contact an elder law attorney or other local financial professional for assistance. You can begin strategizing to save money and better afford retirement from there.

Leverage Technology and Local Resources for Monitoring and Care

Remote patient monitoring and telehealth can fill gaps in care, especially if Medicaid providers become less accessible. Area agencies on aging, senior centers and nutrition programs can provide additional support and financial relief.

How Can You Start Planning Now?

Navigating the new Medicaid rules can be confusing. However, you don't have to do it alone. Schedule a consultation with our experienced estate planning attorneys today. We can discuss how the new rules affect you and help prepare for tomorrow’s care needs.

Key Takeaways

• New Standards and Controversial Rule: The new Medicaid rule, known as the "80/20 rule," mandates that 80% of Medicaid payments for specific services go directly to care workers.
• Impacts on Families: The new rule may increase the cost of elder care. Prepare for this by strategically planning for long-term care.
• Planning Strategies: Comprehensive estate planning can mitigate increases in costs. Consulting with elder law attorneys to develop a strategy accordingly.

Reference: LeadingAge (2024-04-29), "Final Medicaid Access Rule Includes Controversial 80% Compensation Pass-Through"