For patients who struggle with severe mental illness, behavioral home health can serve as one of the few – if not only – tethers between them and the community in which they live. As part of a broader set of services known as skilled home health care, behavioral home health allows these patients to receive physical and mental health care, as well as medication administration and oversight, from the comfort of their own homes, rather than in large institutional settings such as a skilled nursing facility, residential psychiatric hospital, or correctional institution.
According to the Connecticut Association for Healthcare at Home, skilled home health services have saved the state more than $500 million in Medicaid costs over the last decade. Functioning as the only venue of care designed to address acute changes in complex medical conditions that, left unaddressed, send patients into hospitals and other institutional facilities, skilled home health services are a major driver of savings within Connecticut’s Medicaid system.
However, reimbursement rates for critical skilled home health services have been static since 2007, and behavioral home health services were reduced by 15 percent in 2016. The result of the state’s neglecting to make any investments in skilled home health programs in nearly 15 years, is a sector under significant financial stress as there is a direct relationship between reimbursement and the ability of healthcare providers to invest in clinicians and service capabilities.
Fortunately, Connecticut now has an opportunity to address this situation. The state is currently developing its plan for how to use a temporary 10% increase in its federal medical assistance percentage (FMAP), which was included in the recently passed American Rescue Plan Act of 2021 (ARPA). It is critically important that Connecticut uses these funds as a means of providing temporary but much-needed investment across its community-based care continuum. For the community-based care system to work properly, the entire continuum of community-based care must be healthy. Connecticut’s decision not to make a single investment in skilled home health services over the last 14-years is distinctly unhealthy.
Without skilled home health services, many patients, including those enrolled in personal care programs, would not be able to remain in their homes and communities. Never has this care been more important than during the last 15 months of the COVID-19 pandemic.
As an example, consider the real-life story of a 30-year-old patient who lived alone in Bridgeport, with a primary diagnosis of paranoid schizophrenia. When the COVID-19 pandemic hit, his community supports either converted to remote service delivery via telehealth or stopped entirely. His behavioral home health care plan required skilled nursing to address significant physical health issues co-occurrent with his schizophrenia diagnosis and medication administration and monitoring – services that simply could not be “suspended” or successfully delivered “remotely” for this patient.
For months, the only person in this patient’s home each day was his behavioral home health nurse. In fact, he was so dependent on his myriad services that, upon losing them, he asked his behavioral health nurse how he would be able to eat, as the person traditionally assisting with food delivery and preparation was no longer coming to his home. Fortunately, the nurse was equipped to act quickly and ensure placement of a home health aide to enable food delivery and preparation for the patient. This is why he was able to remain in his community throughout the pandemic, and still does today.
I use this example because it frames the criticality of the consistent service delivery of behavioral home health providers, no matter the circumstances. Notwithstanding the great challenges and personal risks of delivering healthcare during the pandemic, Connecticut’s behavioral home health clinicians showed up every day for their patients, like they always do. While this commitment makes all the difference for their patients; these clinicians’ daily efforts are also critical to the health and effectiveness of Connecticut’s broader care continuum.
Recent proposals to use $200 million of ARPA funds to raise personal care attendant wages to $21 per hour and calls for more funding for pediatric home health providers state real and important needs, and while consequential, they neither represent the best use of the temporary ARPA FMAP boost nor provide long-term solutions to stabilize Connecticut’s COVID-19 battered community care continuum. Instead, Connecticut should use the ARPA FMAP boost to provide a 10%, temporary rate add-on for all qualifying home and community based services (HCBS). This simple and straightforward approach will provide some relief to each segment of the care continuum permitting the Connecticut Legislature and Governor Lamont’s Administration the time necessary to plan for the longer term.
While terrible in every respect, the COVID-19 pandemic did make clear our basic interdependence on one another. The same is true where our health systems are concerned, each component needs to work in concert with the other to deliver the maximum benefits for patients. We sincerely hope Connecticut policy makers consider this basic truth and evidence it in Connecticut’s ARPA FMAP plan.
Cale Bradford is the Chief Government Relations Officer at Elara Caring, one of the nation’s largest providers of home and community-based health services and provides daily care for 60,000 beneficiaries in 16 states with over 3,500 behavioral health clients in the greater Bridgeport, New Haven, and Hartford, Connecticut regions.