Why is Medicaid Long Term Insurance not paying home health agencies in a timely manner?

Many agencies are dropping out of Medicaid because the reimbursement rates are too low and Congress is trying to push them even lower. Many people want lower taxes. Cuts to programs is the result.

Medicaid in my state is known for being slow in payments. Thats why doctors don't sign up with them. I have been told, they get paid faster when Medicaid is secondary with Medicare paying the 80%.

It’s imo not so much an issue to find another home health agency, but more a issue that your state is shifting its Medicaid programs budget priority. All the home health companies are in the same spot & have to decide whether to stay as a vendor for a state program & accept state requirements & state payment terms. Medicaid is not paying for “LTC insurance” but rather is reimbursing vendors who have chosen to participate in your states in-home health program & by doing so have agreed to get paid however the state decides to pay its bills and at what rate. I bet they have known about the change for a while but waited till last possible time to tell current clients.

The in home program is being paid via a “waiver” from your state’s LTC Medicaid funds ($ determined by census data). Trend seems that 1-on-1 programs are being phased down or out (either directly or indirectly by vendor attrition- which is basically what the home health company did based on your description); & replaced by PACE or a similar type of community center based full day programs that elder goes to as his entry & first level of care. If there is a PACE program in your area, you need to look ASAP to having hubs be evaluated for & transition into a PACE in your area. Your Area on Aging should have info on PACE or other community based Medicaid programs he can try to get placement into.

If there’s PACE, and if it cannot meet his care plan, only then can he be placed into an in-home program that Medicaid covers. There’s going to be vendors that are still doing in-home & billing the state but I bet are going to be a unit of a much bigger company (like Molina Health).

Medicaid is a joint federal & state program but administration done by each state uniquely, so each state can decide what $ where. Under Medicaid public law (federal) the only program that is required (“dedicated”) by all states to be done is LTC in a skilled nursing care facility (aka care in a NH) & each state can set the “at need” medical & financial determination within overall federal guidelines.
States have to do some type of NH LTC Medicaid coverage & must budget for that. But everything else is budgeted by doing “waiver” programs with Medicaid $ & programs have to basically compete to get $. This is why you’ll read that State X,Y & Z do not ever pay for Assisted Living but State A, B & C do pay for AL. If Medicaid pays for IHHS (in home health services), it’s paid via a waiver from state budget running on 3 or 5 or 7 year cycles. Your state decided to change its in-home waiver funding - probably done last year or so - & now that it’s a wallet reality, vendors are opting out.

There’s going to be another program he can try to show he’s “at need” get into or another in-home care company that is ok with states new reimbursement terms. Really contact your Area on Aging to see what’s what in your region. I’d suggest if you at all can, please private pay for Nov., so he has a continuity of care going on. So there no break in his “need” for services.