At least 80% of Medicaid payments for personal care, homemaker and home health aide services would have to go to the workers' compensation under a rule the Centers for Medicare & Medicaid Services (CMS) proposed on May 3, 2023, according to the Federal Register notice and a CMS fact sheet. The rule was called "Ensuring Access to Medicaid Services."
What else CMS proposed
According to CMS, the proposal also would:
- have states publish, every other year, the average hourly rate paid to direct care workers in certain services
- require states to report on waiting lists and on how quickly people start services
- set standards for incident management systems
- require a grievance process for people in fee-for-service home and community-based services
- have states report on a standard set of HCBS quality measures
Comments were due July 3, 2023.
Why this mattered for providers and DSPs
The 80% proposal works like a federal wage pass-through: it would set how much of each payment reaches the frontline, rather than setting a wage. For provider agencies, the remaining share would have to cover supervision, transportation, administration and other costs. For DSPs, the proposal put frontline pay at the center of a federal Medicaid rule. CMS finalized the rule, with changes, in April 2024.