March 18, 2024 • 25 mins
Drawing from the tapestry of Medicaid policies across the states, this episode explores effective advocacy and the significance of understanding the intricacies that shape care services. Jeff Humber, VP of Payor Relations at Accent Care, shares his experience providing quality care under Medicaid's fixed-cost system. With host Erin Vallier, they discuss strategies for maintaining exceptional care, building relationships with managed care payers, and additional insights on everything from advocacy to caregiver recruitment and retention.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Jeff Humber (00:00):
We are providing care to the Medicaid population,
we can't pass along extra costs, and so part of the struggle
from state to state is helpinglegislators see the impact that
those rates have on our abilityto provide services, primarily
in the hiring and retaining ofcaregivers.
(00:20):
It's important to be able toshow how the services that we
are providing will actuallygenerate a cost savings this
year and the next year and thenext year if we're able to keep
people safely in their homes andout of really expensive
hospitals and nursing facilities.
Erin Vallier (00:48):
Welcome to another episode of the Home Health 360
podcast, where we speak to homebased care professionals from
around the globe.
I'm your host, Erin Vallier,and today I am joined by a dear
friend in the industry JeffHumber.
Jeff lives in Fort Worth,Ginger, so congrats for that 36
(01:12):
years.
Jeff Humber (01:13):
Thank you.
He's a very patient woman.
Erin Vallier (01:16):
You guys have a daughter about to graduate from
the University of Oklahoma too,so that's a double
congratulations.
Jeff Humber (01:23):
Thank you, thank you.
Erin Vallier (01:24):
You're a Sam Bird University graduate that's
worked in health and humanservices in both the public and
the private sector for more than30 years.
Jeff currently serves as a vicepresident for peer relations
for acts of care, which is anational leader of home health,
hospice and personal care, andserves as the co-chair for
(01:46):
government affairs for the TexasAssociation of Home Care and
Hospice.
I'm really excited to have youhere today, jeff.
Jeff Humber (01:54):
Thank you, erin.
It's really good to be herewith you, yeah.
Erin Vallier (01:57):
Before we dive into the topic today, which is
all things Medicaid landscape,could you share with the
audience just exactly what doesit mean to be a VP of peer
relations?
That sounds important.
Jeff Humber (02:13):
Oh my goodness, it's certainly not as important
as the people who are actuallyin the homes providing the care
to our clients and our patients.
We have some incrediblecaregivers and accent care.
We have personal careassistants in the home.
We have nurses, therapists allover the country.
But with my role it's a lot ofdifferent hats, Erin.
(02:34):
Sometimes in my role I findmyself teaming up a new
relationship with a managed carepayer, joining them with our
contracting and credentialingteam, especially if they are new
to a market.
Sometimes my job, and reallyall the time, it's about the
growth of the company.
How do we utilize thispartnership with a Medicaid
(02:58):
managed care payer, whether it'san insurance company or a state
agency, to grow our businessand really develop our impact in
communities?
Sometimes it's introducingservice coordinators within that
payer to our frontline staff tomake sure that relationship is
complete.
One thing that I really enjoydoing is working with managed
(03:22):
care organizations on valuebased plans, where we are going
above and beyond what the stateregulatory agency says we must
do, but we're actually strivingto meet better healthcare
outcomes for the folks thatwe're serving.
And then we can also weep intoindividual customer service
(03:42):
issues, bringing the managedcare organization to the table
if we need to address someproblems, some challenge and
working with a particularpatient or client.
Erin Vallier (03:52):
That's a lot, and it does sound very important.
Introducing new payer sourcesso that you can diversify, which
that's super important, andthen managing to grow the
relationship within the existingpayers is what I've got.
That's extremely important tothe success of any business.
So I'm glad you're the onetalking about this today.
I'm sure you're going to befull of all of the knowledge
(04:14):
that everybody is itching tolearn about Medicaid.
Now, when you talk aboutMedicaid, it's really difficult
to talk in absolutes, becauseeach state has the liberty to do
things differently.
Jeff Humber (04:26):
Very true.
Erin Vallier (04:27):
So one of the most common variances that you see
from state to state.
Jeff Humber (04:32):
You know, I wish I could put this on a t-shirt or a
bumper sticker, but if you, ifMedicaid in one state, you know
it in just one state because itreally does take on a different
meeting, a different legislativeintent, a different payer,
patient intent in every state.
Some of the things that we seesimilarly is probably the focus
(04:56):
of Medicaid managed care onassessing and generating the
authorizations that provide thatallow us to provide service to
their members State to state.
Typically, a state agency ownsthe eligibility decision and
then, depending on what programthat patient or that client
(05:20):
finds themselves in whether it'sa waiver program each state
decides how they spin that off.
That person and I'll speak toTexas, for instance is then
assigned to a Medicaid managedcare payer For Texas.
There are different categories.
There are children's healthinsurance programs.
We have star kids, we have thechip program.
(05:40):
The program that works with ourseniors and the disabled
population is called star plus.
There are four MCOs in Texasthat have that contract to
manage the care of those clientsand patients in Texas.
Some states will handle theirown assessment post eligibility.
(06:01):
For instance, a state agencymay choose to have one of their
own nurses go to the home andassess the client for their
ability to handle all of theactivities of daily living
coaching, cleaning, ambulating,those kinds of things.
Some states will only handlethe eligibility piece but then
(06:23):
pass the assessment on to a casemanagement agency that they
contract with or one of theMedicaid managed care MCOs.
Erin Vallier (06:34):
It seems like it might be.
Jeff Humber (06:36):
It really is.
It really can change from stateto state.
For instance, in Texas for thestar plus program, those four
managed care organizationshandle their own assessment.
They decide how many hours perweek, per month, a client would
receive of in-home personal care.
Erin Vallier (06:55):
Depending on what state you're working in, the
eligibility criteria changes andthen how that eligibility is
managed.
It could either be the stategoing in and deciding what you
can do, or they pass it to acare manager, or they may pass
it to agency themselves.
You really got to know yourstuff if you're planning to work
across multiple states, is whatI'm hearing.
Jeff Humber (07:18):
It pays to really study the state regulations of
any state that you want toprovide services in to know what
your role is going to be as aprovider of care.
Where will you be the best fit?
What parties will you becontracting with?
Will you be contractingdirectly with a state entity?
Will you be contractingdirectly with an insurance
(07:40):
company, like a Medicaid managedcare organization?
Erin Vallier (07:43):
That's a lot.
You need a dedicated resourceper state.
I know that states differ a lotin their Medicaid structures,
just by what you've mentioned,but there's undoubtedly some
governance aspects that remainconsistent.
It is a government provider,right.
They don't want to haveeverything completely different.
(08:05):
So what are some of the sharedelements that happen to
transcend those state boundaries?
Jeff Humber (08:12):
You're right in that the state agencies also
have to follow CMS guidelinesfor Medicaid.
There are going to be similarcriteria for Medicaid
eligibility across many states.
One example that we've seen mostrecently, as states are now
unwinding what happened duringCOVID with eligibility, is CMS
(08:35):
can dictate to a state whetheror not they can, let's say,
break eligibility or endeligibility because of a public
health emergency.
At one time CMS said statesduring this period of time for
people who are on the Medicaidprogram in your state for these
programs and where they wouldtypically come off of
(08:57):
eligibility if they didn't meetcertain criteria, they'll shall
keep them on right now.
And so CMS exercised that kindof muscle with the states.
But since the public healthemergency is now over, states
are now unwinding that andyou've probably heard quite a
bit in the news of some of thechallenges that some states are
(09:18):
facing with people who had beenon Medicaid and now they're not,
either because theireligibility changed maybe they
had an increase of resources orincome or they just didn't turn
in their paperwork and it's moreof an administrative decision.
Cms still has authority overstates in some areas of policy,
(09:41):
but those states do have quite abit of autonomy as to how that
is handled at the local level.
Erin Vallier (09:48):
Gotcha.
So it's multi-layered, whichmakes it even that much more
complex to be successful as aMedicaid business.
Wow, it is.
So that sounds like it's reallycrucial that agencies advocate
for themselves to securereimbursement rates and the
flexibilities that they need inorder to deliver the quality
care that they want to deliver.
(10:10):
How can organizationseffectively advocate for
themselves in the complexenvironment.
Jeff Humber (10:16):
Sure, that's a great question, and agencies
need to advocate for themselvesas a business, but also, and
very importantly, for the verypeople that they care for.
You know, it's our job to makea positive impact in the lives
of the people that we serve.
The best way to do that is toensure that we are compliant
with state regulations, but alsothat those state regulations
(10:40):
help us provide the best carepossible to those patients and
clients.
So I'm going to hit this acouple of different ways from
state to state.
The Medicaid reimbursementrates that are paid will differ
greatly from state to state.
For instance, in one state inthe Pacific Northwest, a
(11:01):
Medicaid reimbursement ratemight be in the neighborhood of
$27 per hour, and of that thatgives you enough flexibility to
be able to hire a caregiver andkeep those caregivers and retain
those caregivers.
In other states, thatreimbursement rate may just be
in the neighborhood of $12 to$14 an hour, and it becomes more
(11:25):
difficult to hire with fruitand retain caregivers, as those
caregivers are generally in apool of direct care workers that
are also being hired by therestaurant industry, by the
hotel industry, those industries, as the economy changes, they
(11:48):
can pass along extra costs totheir customers.
However, when we are providingcare to the Medicaid population,
we can't pass along extra costs, and so part of the struggle
from state to state is helpinglegislators see the impact that
those rates have on our abilityto provide services, primarily
(12:11):
in the hiring and retaining ofcaregivers.
We want to really draw thepicture for our legislators as
to what that looks like.
Let them see the plight of theindividuals in their districts
that we're serving.
Let them understand how puttinga caregiver into a home,
putting a nurse into a home youknow, coupling a nurse with the
(12:34):
family of a child with adisability can positively impact
that family, help keep thatindividual out of an expensive
nursing home environment andhelp that individual retain
independence ongoing.
I think there's thatperspective from the client, the
(12:55):
patient side, as far asretaining independence and
maintaining that that's soimportant.
But legislators are oftenworking with very challenging
state budgets and so they do thebest they can with the money
that they have to work with andthey have spending limits.
Some of those are statutory.
(13:15):
So again, it's important to beable to show how the services
that we are providing willactually generate a cost savings
this year and the next year andthe next year If we're able to
keep people safely in theirhomes and out of really
expensive hospitals and nursingfacilities.
Erin Vallier (13:34):
It sounds like a real complex argument where you
need the data to back it up, butyou also need to pull on their
heartstrings, because they havea loved one that's aging and
they want them to stay in thehome.
Now my question for you is whatdata are you using and how do
you organize it, because it'snot just from one agency.
You got to have a group, I'massuming, because strength comes
(13:58):
in numbers.
How do you go about that?
Jeff Humber (14:00):
Yeah, I would look at the state regulatory agency's
information.
So they're going to havenumbers of people on certain
Medicaid programs grouped bycounty, grouped by region, and
the ability to tell a legislatorhey, you have this many people
that are being served with thistype of service in your county.
This is why it's important foryou to understand the plight of
(14:23):
those people so you can workwith a state regulatory agency
and I would also recommend youwork with your state's
association.
For instance, you havementioned my involvement with
TAC, the Texas Association ofHome Care and Hospice.
They will have people who, on aregular basis, professionally
(14:44):
educate legislators, but theyalso are very much tied to their
state's regulatory agenciesdiving for that data and you may
not have to go to the stateregulatory agency.
That state association may havea plethora of information to
help you really put togetherthat care message to a
legislator that you're talkingto.
(15:05):
As we pull together that dataand we share that with the
legislators, very often you willhave legislators that are on
really important committees, soyour state's finance committee
whether it's the Senate FinanceCommittee or House
Appropriations or Senator of theHouse, Health and Human
Services Committee you reallywant to focus on the members of
(15:26):
that committee and their staffmembers.
Usually, a legislator will havea staff member whose sole focus
is healthcare, for instance, orsome other industry.
You want to get to know thatperson.
They will be educated on theprograms that you work with them
, but they may have questionsoccasionally.
(15:47):
They want to know how this willimpact you as a provider.
You want them calling you right.
So you really want to setyourself up as a resource for
those folks who are in alegislative capacity.
Erin Vallier (16:02):
It's a very strategic approach.
So partner with your stateassociation.
I think Texas has a really niceactive association where I get
them.
Sometimes it's hey, son, thispetition, we have a voice going
in and lobbying.
So I guess the recommendationto the listeners would be if you
(16:24):
see any of that, get involved,go talk to them and make
yourself the go to person ifthey have questions.
I like it, but it's complicated, sounds like it takes a lot of
dedication From your perspective.
Jeff, what disparities exist inmanaged care from state to
state?
You've mentioned managed care acouple of times, and how do
(16:44):
these disparities impacthealthcare delivery?
Jeff Humber (16:46):
Thank you, Sure, I think the way that state
legislature or a stateregulatory agency, it's all
about the contract that theyhave with those managed chair
organizations.
What are they prescribing thosemanaged chair organizations to
do?
It's really important asproviders, if you're contracted
(17:07):
with a Medicaid MCO, it mayreally be great nighttime
reading right before you go tobed but get a copy of that state
uniform contract between yourstate regulatory agency and the
Medicaid managed careorganization.
It's really enlightening and itwill help you understand the
roles of that managed chairorganizations and how it may
(17:29):
differ from state to state.
Again, I think some of thedisparities we will see will be
how individuals are assessed todetermine the number of hours,
of the number of days thatpatient or client might receive
for caregiving, let's say.
Some disparities also lie inhow an organization is
(17:51):
reimbursed for care, how aprovider is reimbursed for care.
Maybe they are only reimbursedfor the actual care that's given
.
Some states will require MCOsto also pay for the supervision
of that care.
Again, you want to peel thelayers back a little bit and see
what's there from reimbursementperspectives, what is there
(18:15):
from the assessment perspectivesand how you go about receiving
your authorizations for care,whether it's from that MCO
directly or through anotherparty.
Erin Vallier (18:24):
Yeah, All important information to know if
you're going to deliver careand also if you're going to go
talk to your legislators andtell them exactly what you want.
Jeff Humber (18:33):
That's right.
Let's keep in mind the plightof the individual receiving care
.
I don't want to sound like I'mbuilding a stereotype, but for a
person of age who may also bedealing with some level of
Alzheimer's or dementia, andthat family member that's
helping to take care of them ishaving to make some decisions
and figure things out on theirown, going through the
(18:53):
eligibility process, it's toughenough, but then they're going
to be faced with a choice.
Okay, what health plan do youwant to go with?
What are the differences?
Okay, now you're with thehealth plan.
The health plan is going tocome visit you.
They're going to share with youa list of services that they
can provide.
Then you get to decide whatagency provides those services
(19:14):
in your home.
Just becoming eligible starts awhole road of really important
life decisions in the journey ofthat person's healthcare.
It's important that ourlegislators understand what that
journey is like for the peoplewho are being served.
Erin Vallier (19:36):
I completely agree .
How about question about thevariety of things that Medicaid
offers?
I know that because there's somuch variability in autonomy
among the states, there's got tobe this giant portfolio of
services and programs that someof them probably aren't widely
(19:57):
known and it could be a realopportunity for providers to dip
into that if they'reconsidering getting into
Medicaid very seriously.
Can you shed some light on anyof those lesser known but
valuable services availablethrough the Medicaid program?
Jeff Humber (20:10):
Medicaid allows me to see my doctor.
Medicaid allows me to get intothe hospital or the ER if I need
to.
Medicaid allows me to havecaregivers coming into my home
to help me with cooking andcleaning and those activities of
daily living.
But relationships with thosemanaged care organizations can
also open up avenues to personaland residency response services
(20:32):
.
You might remember the oldcommercial I've fallen and I
can't get up.
Individuals on Medicaid waiverprograms can have that device
paid for, so that provides anadditional safety net to them.
Dental services may be availablethrough the state's Medicaid
program or that managed careorganization.
Medical transportation, so toand from your doctor or other
(20:57):
place of treatment.
Dysical therapy, speech therapy, occupational therapy, the use
of medical equipment I need awheelchair in a home, I need a
walkthrough in a home, I need ahospital bed in a home.
You want to communicate withyour managed care organization
for those things and also I'llframe this as PCP appointment
(21:17):
management the ability to callyour managed care organization
and have them set up yourphysician appointments and then
your caregiver, who should knowwhen those are and help make
sure that you are making thoseappointments by accompanying you
to your appointment.
So those are some otherservices that a Medicaid managed
(21:38):
care organization can helpprovide.
Erin Vallier (21:40):
That's a lot, and it gives agencies a lot of
opportunities to expand some ofthe services they're providing.
So that's pretty exciting.
I have one final question foryou, jeff, because I know we're
approaching our time what is thesingle most important piece of
advice you could give ourlisteners that will help them
navigate the Medicaid landscape?
Jeff Humber (22:02):
Yes I would say don't assume that you know
everything about your state,because it's a moving target, as
new orders come from the fedsthrough CMS, or there are
budgetary changes that have tobe addressed or client or
patient care needs that have tobe addressed by your state's
(22:23):
legislature.
You want to stay informed, sostay involved, stay informed,
get involved.
I would say get on yourregulatory agencies D list for
any program changes for theprograms that you work within,
and if you contact their publicinformation officer's office,
they will tell you how to dothat.
(22:43):
That's a really good thing todo.
Be your legislative partner'sbest friend and resource.
Be that person that they callwhen one of their constituents
calls and asks a question.
You want them to call you foryour perspective.
Stay involved with your stateindustry association for home
(23:03):
care and hospice.
And back to the legislatorsagain.
Don't just wait for thelegislative session to come to
make visits to those folks.
They get inundated with visits,people asking for things right
around the legislative sessionwhen all of those votes are
happening.
Set a regular cadence.
Go visit them quarterly orsemi-annually.
(23:25):
Make sure that they see you ona regular basis and that will
really help build thatrelationship with them.
Erin Vallier (23:32):
Excellent advice.
So stay on your toes, stayinformed, get involved and build
a relationship with the peoplethat matter in the industry.
I love it.
Jeff Humber (23:41):
That's right.
You're advocating not just foryour business, but for the
people that you're serving, andthose are definitely some ways
to do that.
Erin Vallier (23:48):
Fantastic, Jeff.
I really appreciate you hoppingon the show today and sharing
all of this wisdom with thelisteners.
I am sure they have come awaywith a ton of actionable
insights.
It's been a pleasure.
Jeff Humber (24:02):
Well, thank you for having me.
It's been a pleasure, and Iwork for Accent Care.
We provide home health, hospice, palliative care and personal
care throughout the country.
We're in 31 states.
We're based in Texas.
If I can be a resource at allfor your listeners, please let
me know.
Erin Vallier (24:20):
Fantastic.
We'll make sure that there'ssomething in the show notes to
let them know how they can findyou and find Accent Care.
Jeff Humber (24:27):
That would be great .
Thank you very much, excellent.
Erin Vallier (24:30):
Thank you or visit us on your favorite podcast
(25:01):
platform.
We are providing care to the Medicaid population,
we can't pass along extra costs, and so part of the struggle
from state to state is helpinglegislators see the impact that
those rates have on our abilityto provide services, primarily
in the hiring and retaining ofcaregivers.
(00:20):
It's important to be able toshow how the services that we
are providing will actuallygenerate a cost savings this
year and the next year and thenext year if we're able to keep
people safely in their homes andout of really expensive
hospitals and nursing facilities.
Erin Vallier (00:48):
Welcome to another episode of the Home Health 360
podcast, where we speak to homebased care professionals from
around the globe.
I'm your host, Erin Vallier,and today I am joined by a dear
friend in the industry JeffHumber.
Jeff lives in Fort Worth,Ginger, so congrats for that 36
(01:12):
years.
Jeff Humber (01:13):
Thank you.
He's a very patient woman.
Erin Vallier (01:16):
You guys have a daughter about to graduate from
the University of Oklahoma too,so that's a double
congratulations.
Jeff Humber (01:23):
Thank you, thank you.
Erin Vallier (01:24):
You're a Sam Bird University graduate that's
worked in health and humanservices in both the public and
the private sector for more than30 years.
Jeff currently serves as a vicepresident for peer relations
for acts of care, which is anational leader of home health,
hospice and personal care, andserves as the co-chair for
(01:46):
government affairs for the TexasAssociation of Home Care and
Hospice.
I'm really excited to have youhere today, jeff.
Jeff Humber (01:54):
Thank you, erin.
It's really good to be herewith you, yeah.
Erin Vallier (01:57):
Before we dive into the topic today, which is
all things Medicaid landscape,could you share with the
audience just exactly what doesit mean to be a VP of peer
relations?
That sounds important.
Jeff Humber (02:13):
Oh my goodness, it's certainly not as important
as the people who are actuallyin the homes providing the care
to our clients and our patients.
We have some incrediblecaregivers and accent care.
We have personal careassistants in the home.
We have nurses, therapists allover the country.
But with my role it's a lot ofdifferent hats, Erin.
(02:34):
Sometimes in my role I findmyself teaming up a new
relationship with a managed carepayer, joining them with our
contracting and credentialingteam, especially if they are new
to a market.
Sometimes my job, and reallyall the time, it's about the
growth of the company.
How do we utilize thispartnership with a Medicaid
(02:58):
managed care payer, whether it'san insurance company or a state
agency, to grow our businessand really develop our impact in
communities?
Sometimes it's introducingservice coordinators within that
payer to our frontline staff tomake sure that relationship is
complete.
One thing that I really enjoydoing is working with managed
(03:22):
care organizations on valuebased plans, where we are going
above and beyond what the stateregulatory agency says we must
do, but we're actually strivingto meet better healthcare
outcomes for the folks thatwe're serving.
And then we can also weep intoindividual customer service
(03:42):
issues, bringing the managedcare organization to the table
if we need to address someproblems, some challenge and
working with a particularpatient or client.
Erin Vallier (03:52):
That's a lot, and it does sound very important.
Introducing new payer sourcesso that you can diversify, which
that's super important, andthen managing to grow the
relationship within the existingpayers is what I've got.
That's extremely important tothe success of any business.
So I'm glad you're the onetalking about this today.
I'm sure you're going to befull of all of the knowledge
(04:14):
that everybody is itching tolearn about Medicaid.
Now, when you talk aboutMedicaid, it's really difficult
to talk in absolutes, becauseeach state has the liberty to do
things differently.
Jeff Humber (04:26):
Very true.
Erin Vallier (04:27):
So one of the most common variances that you see
from state to state.
Jeff Humber (04:32):
You know, I wish I could put this on a t-shirt or a
bumper sticker, but if you, ifMedicaid in one state, you know
it in just one state because itreally does take on a different
meeting, a different legislativeintent, a different payer,
patient intent in every state.
Some of the things that we seesimilarly is probably the focus
(04:56):
of Medicaid managed care onassessing and generating the
authorizations that provide thatallow us to provide service to
their members State to state.
Typically, a state agency ownsthe eligibility decision and
then, depending on what programthat patient or that client
(05:20):
finds themselves in whether it'sa waiver program each state
decides how they spin that off.
That person and I'll speak toTexas, for instance is then
assigned to a Medicaid managedcare payer For Texas.
There are different categories.
There are children's healthinsurance programs.
We have star kids, we have thechip program.
(05:40):
The program that works with ourseniors and the disabled
population is called star plus.
There are four MCOs in Texasthat have that contract to
manage the care of those clientsand patients in Texas.
Some states will handle theirown assessment post eligibility.
(06:01):
For instance, a state agencymay choose to have one of their
own nurses go to the home andassess the client for their
ability to handle all of theactivities of daily living
coaching, cleaning, ambulating,those kinds of things.
Some states will only handlethe eligibility piece but then
(06:23):
pass the assessment on to a casemanagement agency that they
contract with or one of theMedicaid managed care MCOs.
Erin Vallier (06:34):
It seems like it might be.
Jeff Humber (06:36):
It really is.
It really can change from stateto state.
For instance, in Texas for thestar plus program, those four
managed care organizationshandle their own assessment.
They decide how many hours perweek, per month, a client would
receive of in-home personal care.
Erin Vallier (06:55):
Depending on what state you're working in, the
eligibility criteria changes andthen how that eligibility is
managed.
It could either be the stategoing in and deciding what you
can do, or they pass it to acare manager, or they may pass
it to agency themselves.
You really got to know yourstuff if you're planning to work
across multiple states, is whatI'm hearing.
Jeff Humber (07:18):
It pays to really study the state regulations of
any state that you want toprovide services in to know what
your role is going to be as aprovider of care.
Where will you be the best fit?
What parties will you becontracting with?
Will you be contractingdirectly with a state entity?
Will you be contractingdirectly with an insurance
(07:40):
company, like a Medicaid managedcare organization?
Erin Vallier (07:43):
That's a lot.
You need a dedicated resourceper state.
I know that states differ a lotin their Medicaid structures,
just by what you've mentioned,but there's undoubtedly some
governance aspects that remainconsistent.
It is a government provider,right.
They don't want to haveeverything completely different.
(08:05):
So what are some of the sharedelements that happen to
transcend those state boundaries?
Jeff Humber (08:12):
You're right in that the state agencies also
have to follow CMS guidelinesfor Medicaid.
There are going to be similarcriteria for Medicaid
eligibility across many states.
One example that we've seen mostrecently, as states are now
unwinding what happened duringCOVID with eligibility, is CMS
(08:35):
can dictate to a state whetheror not they can, let's say,
break eligibility or endeligibility because of a public
health emergency.
At one time CMS said statesduring this period of time for
people who are on the Medicaidprogram in your state for these
programs and where they wouldtypically come off of
(08:57):
eligibility if they didn't meetcertain criteria, they'll shall
keep them on right now.
And so CMS exercised that kindof muscle with the states.
But since the public healthemergency is now over, states
are now unwinding that andyou've probably heard quite a
bit in the news of some of thechallenges that some states are
(09:18):
facing with people who had beenon Medicaid and now they're not,
either because theireligibility changed maybe they
had an increase of resources orincome or they just didn't turn
in their paperwork and it's moreof an administrative decision.
Cms still has authority overstates in some areas of policy,
(09:41):
but those states do have quite abit of autonomy as to how that
is handled at the local level.
Erin Vallier (09:48):
Gotcha.
So it's multi-layered, whichmakes it even that much more
complex to be successful as aMedicaid business.
Wow, it is.
So that sounds like it's reallycrucial that agencies advocate
for themselves to securereimbursement rates and the
flexibilities that they need inorder to deliver the quality
care that they want to deliver.
(10:10):
How can organizationseffectively advocate for
themselves in the complexenvironment.
Jeff Humber (10:16):
Sure, that's a great question, and agencies
need to advocate for themselvesas a business, but also, and
very importantly, for the verypeople that they care for.
You know, it's our job to makea positive impact in the lives
of the people that we serve.
The best way to do that is toensure that we are compliant
with state regulations, but alsothat those state regulations
(10:40):
help us provide the best carepossible to those patients and
clients.
So I'm going to hit this acouple of different ways from
state to state.
The Medicaid reimbursementrates that are paid will differ
greatly from state to state.
For instance, in one state inthe Pacific Northwest, a
(11:01):
Medicaid reimbursement ratemight be in the neighborhood of
$27 per hour, and of that thatgives you enough flexibility to
be able to hire a caregiver andkeep those caregivers and retain
those caregivers.
In other states, thatreimbursement rate may just be
in the neighborhood of $12 to$14 an hour, and it becomes more
(11:25):
difficult to hire with fruitand retain caregivers, as those
caregivers are generally in apool of direct care workers that
are also being hired by therestaurant industry, by the
hotel industry, those industries, as the economy changes, they
(11:48):
can pass along extra costs totheir customers.
However, when we are providingcare to the Medicaid population,
we can't pass along extra costs, and so part of the struggle
from state to state is helpinglegislators see the impact that
those rates have on our abilityto provide services, primarily
(12:11):
in the hiring and retaining ofcaregivers.
We want to really draw thepicture for our legislators as
to what that looks like.
Let them see the plight of theindividuals in their districts
that we're serving.
Let them understand how puttinga caregiver into a home,
putting a nurse into a home youknow, coupling a nurse with the
(12:34):
family of a child with adisability can positively impact
that family, help keep thatindividual out of an expensive
nursing home environment andhelp that individual retain
independence ongoing.
I think there's thatperspective from the client, the
(12:55):
patient side, as far asretaining independence and
maintaining that that's soimportant.
But legislators are oftenworking with very challenging
state budgets and so they do thebest they can with the money
that they have to work with andthey have spending limits.
Some of those are statutory.
(13:15):
So again, it's important to beable to show how the services
that we are providing willactually generate a cost savings
this year and the next year andthe next year If we're able to
keep people safely in theirhomes and out of really
expensive hospitals and nursingfacilities.
Erin Vallier (13:34):
It sounds like a real complex argument where you
need the data to back it up, butyou also need to pull on their
heartstrings, because they havea loved one that's aging and
they want them to stay in thehome.
Now my question for you is whatdata are you using and how do
you organize it, because it'snot just from one agency.
You got to have a group, I'massuming, because strength comes
(13:58):
in numbers.
How do you go about that?
Jeff Humber (14:00):
Yeah, I would look at the state regulatory agency's
information.
So they're going to havenumbers of people on certain
Medicaid programs grouped bycounty, grouped by region, and
the ability to tell a legislatorhey, you have this many people
that are being served with thistype of service in your county.
This is why it's important foryou to understand the plight of
(14:23):
those people so you can workwith a state regulatory agency
and I would also recommend youwork with your state's
association.
For instance, you havementioned my involvement with
TAC, the Texas Association ofHome Care and Hospice.
They will have people who, on aregular basis, professionally
(14:44):
educate legislators, but theyalso are very much tied to their
state's regulatory agenciesdiving for that data and you may
not have to go to the stateregulatory agency.
That state association may havea plethora of information to
help you really put togetherthat care message to a
legislator that you're talkingto.
(15:05):
As we pull together that dataand we share that with the
legislators, very often you willhave legislators that are on
really important committees, soyour state's finance committee
whether it's the Senate FinanceCommittee or House
Appropriations or Senator of theHouse, Health and Human
Services Committee you reallywant to focus on the members of
(15:26):
that committee and their staffmembers.
Usually, a legislator will havea staff member whose sole focus
is healthcare, for instance, orsome other industry.
You want to get to know thatperson.
They will be educated on theprograms that you work with them
, but they may have questionsoccasionally.
(15:47):
They want to know how this willimpact you as a provider.
You want them calling you right.
So you really want to setyourself up as a resource for
those folks who are in alegislative capacity.
Erin Vallier (16:02):
It's a very strategic approach.
So partner with your stateassociation.
I think Texas has a really niceactive association where I get
them.
Sometimes it's hey, son, thispetition, we have a voice going
in and lobbying.
So I guess the recommendationto the listeners would be if you
(16:24):
see any of that, get involved,go talk to them and make
yourself the go to person ifthey have questions.
I like it, but it's complicated, sounds like it takes a lot of
dedication From your perspective.
Jeff, what disparities exist inmanaged care from state to
state?
You've mentioned managed care acouple of times, and how do
(16:44):
these disparities impacthealthcare delivery?
Jeff Humber (16:46):
Thank you, Sure, I think the way that state
legislature or a stateregulatory agency, it's all
about the contract that theyhave with those managed chair
organizations.
What are they prescribing thosemanaged chair organizations to
do?
It's really important asproviders, if you're contracted
(17:07):
with a Medicaid MCO, it mayreally be great nighttime
reading right before you go tobed but get a copy of that state
uniform contract between yourstate regulatory agency and the
Medicaid managed careorganization.
It's really enlightening and itwill help you understand the
roles of that managed chairorganizations and how it may
(17:29):
differ from state to state.
Again, I think some of thedisparities we will see will be
how individuals are assessed todetermine the number of hours,
of the number of days thatpatient or client might receive
for caregiving, let's say.
Some disparities also lie inhow an organization is
(17:51):
reimbursed for care, how aprovider is reimbursed for care.
Maybe they are only reimbursedfor the actual care that's given
.
Some states will require MCOsto also pay for the supervision
of that care.
Again, you want to peel thelayers back a little bit and see
what's there from reimbursementperspectives, what is there
(18:15):
from the assessment perspectivesand how you go about receiving
your authorizations for care,whether it's from that MCO
directly or through anotherparty.
Erin Vallier (18:24):
Yeah, All important information to know if
you're going to deliver careand also if you're going to go
talk to your legislators andtell them exactly what you want.
Jeff Humber (18:33):
That's right.
Let's keep in mind the plightof the individual receiving care
.
I don't want to sound like I'mbuilding a stereotype, but for a
person of age who may also bedealing with some level of
Alzheimer's or dementia, andthat family member that's
helping to take care of them ishaving to make some decisions
and figure things out on theirown, going through the
(18:53):
eligibility process, it's toughenough, but then they're going
to be faced with a choice.
Okay, what health plan do youwant to go with?
What are the differences?
Okay, now you're with thehealth plan.
The health plan is going tocome visit you.
They're going to share with youa list of services that they
can provide.
Then you get to decide whatagency provides those services
(19:14):
in your home.
Just becoming eligible starts awhole road of really important
life decisions in the journey ofthat person's healthcare.
It's important that ourlegislators understand what that
journey is like for the peoplewho are being served.
Erin Vallier (19:36):
I completely agree .
How about question about thevariety of things that Medicaid
offers?
I know that because there's somuch variability in autonomy
among the states, there's got tobe this giant portfolio of
services and programs that someof them probably aren't widely
(19:57):
known and it could be a realopportunity for providers to dip
into that if they'reconsidering getting into
Medicaid very seriously.
Can you shed some light on anyof those lesser known but
valuable services availablethrough the Medicaid program?
Jeff Humber (20:10):
Medicaid allows me to see my doctor.
Medicaid allows me to get intothe hospital or the ER if I need
to.
Medicaid allows me to havecaregivers coming into my home
to help me with cooking andcleaning and those activities of
daily living.
But relationships with thosemanaged care organizations can
also open up avenues to personaland residency response services
(20:32):
.
You might remember the oldcommercial I've fallen and I
can't get up.
Individuals on Medicaid waiverprograms can have that device
paid for, so that provides anadditional safety net to them.
Dental services may be availablethrough the state's Medicaid
program or that managed careorganization.
Medical transportation, so toand from your doctor or other
(20:57):
place of treatment.
Dysical therapy, speech therapy, occupational therapy, the use
of medical equipment I need awheelchair in a home, I need a
walkthrough in a home, I need ahospital bed in a home.
You want to communicate withyour managed care organization
for those things and also I'llframe this as PCP appointment
(21:17):
management the ability to callyour managed care organization
and have them set up yourphysician appointments and then
your caregiver, who should knowwhen those are and help make
sure that you are making thoseappointments by accompanying you
to your appointment.
So those are some otherservices that a Medicaid managed
(21:38):
care organization can helpprovide.
Erin Vallier (21:40):
That's a lot, and it gives agencies a lot of
opportunities to expand some ofthe services they're providing.
So that's pretty exciting.
I have one final question foryou, jeff, because I know we're
approaching our time what is thesingle most important piece of
advice you could give ourlisteners that will help them
navigate the Medicaid landscape?
Jeff Humber (22:02):
Yes I would say don't assume that you know
everything about your state,because it's a moving target, as
new orders come from the fedsthrough CMS, or there are
budgetary changes that have tobe addressed or client or
patient care needs that have tobe addressed by your state's
(22:23):
legislature.
You want to stay informed, sostay involved, stay informed,
get involved.
I would say get on yourregulatory agencies D list for
any program changes for theprograms that you work within,
and if you contact their publicinformation officer's office,
they will tell you how to dothat.
(22:43):
That's a really good thing todo.
Be your legislative partner'sbest friend and resource.
Be that person that they callwhen one of their constituents
calls and asks a question.
You want them to call you foryour perspective.
Stay involved with your stateindustry association for home
(23:03):
care and hospice.
And back to the legislatorsagain.
Don't just wait for thelegislative session to come to
make visits to those folks.
They get inundated with visits,people asking for things right
around the legislative sessionwhen all of those votes are
happening.
Set a regular cadence.
Go visit them quarterly orsemi-annually.
(23:25):
Make sure that they see you ona regular basis and that will
really help build thatrelationship with them.
Erin Vallier (23:32):
Excellent advice.
So stay on your toes, stayinformed, get involved and build
a relationship with the peoplethat matter in the industry.
I love it.
Jeff Humber (23:41):
That's right.
You're advocating not just foryour business, but for the
people that you're serving, andthose are definitely some ways
to do that.
Erin Vallier (23:48):
Fantastic, Jeff.
I really appreciate you hoppingon the show today and sharing
all of this wisdom with thelisteners.
I am sure they have come awaywith a ton of actionable
insights.
It's been a pleasure.
Jeff Humber (24:02):
Well, thank you for having me.
It's been a pleasure, and Iwork for Accent Care.
We provide home health, hospice, palliative care and personal
care throughout the country.
We're in 31 states.
We're based in Texas.
If I can be a resource at allfor your listeners, please let
me know.
Erin Vallier (24:20):
Fantastic.
We'll make sure that there'ssomething in the show notes to
let them know how they can findyou and find Accent Care.
Jeff Humber (24:27):
That would be great .
Thank you very much, excellent.
Erin Vallier (24:30):
Thank you or visit us on your favorite podcast
(25:01):
platform.
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