Over the summer of 2024, legacy NAHC (now the Alliance) surveyed members regarding important measures of access to Medicaid-funded home and community-based services. The survey focused on two main issues:
- the proportion of Medicaid-funded referrals that providers accept or reject; and
- the proportion of authorized Medicaid services that are actually delivered by the provider.
The survey also collected information regarding reasons why referrals are rejected and hours are left unfilled.
Important findings from the survey include:
- Rejection rates were highest for Private Duty Nursing (64%) and lowest for skilled home health services (i.e. Home Health Nursing) at 39%.
- Nearly two-thirds of respondents (63.89%) reported low reimbursement rates as one of the top three reasons for rejecting referrals
- Caregiver shortages, which are related to the low pay and poor benefits resulting from inadequate reimbursements, was the second most commonly reported reason for a referral rejection (55.56%).
- Medicaid fill-rates for selected home care services ranged from 71% for home health aide services to 85% for home health nursing services.
- The overall percentage of hours provided was significantly higher than the acceptance rate, suggesting that agencies use referral rejection as the primary process for aligning workload with available caregivers.
- Lack of caregivers was a significant reason for unfilled hours (63.83% of respondents).
- No other reason for unfilled hours was cited by more than 50% of respondents.
The Alliance intends to continuously update this report to reflect additional information as it is received. If your organization has not yet responded to the survey, we encourage you to fill it out HERE.
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Damon Terzaghi
Director of Medicaid Advocacy
The National Alliance for Care at Home
Washington DC
+1 (202) 547-7424
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