Senators urge expansion of HCBS, telehealth

Lawmakers and public policy experts are calling on Congress to expand home- and community-based services (HCBS) and telehealth as the U.S. emerges from the deadly COVID-19 pandemic.

During a hearing of the U.S. Senate Special Committee on Aging Thursday, Sen. Elizabeth Warren (D-MA) said HCBS should be a mandatory benefit under Medicaid and should be expanded under Medicare to cover more home care and long-term care services for seniors.

“If you’re not well off and able to pay out of your own pocket for everything you need to live at your home or you don’t have a family member who can drop everything to help, you’re pretty much on your own,” Warren said.

Medicaid covers skilled nursing for the poor in all states and in-home services in some states. Medicare covers some part-time skilled nursing services and in-home therapy but doesn’t cover activities of daily living, such as bathing, dressing and eating.

Telehealth push

During the virtual hearing, participants also advocated for telehealth. Anthony Jackson, COO of Charleston, SC-based Roger St. Francis Healthcare, told the committee his hospital scaled up telehealth during the pandemic and wants to increase its use another 20%. “(It) opens the door for many vulnerable older Americans — particularly those who are homebound, disabled and live in rural areas,” said Jackson. 

Sen. Tim Scott (R-SC) said telehealth should “be a permanent feature of our healthcare system going forward.”

Jackson and Scott’s comments support the findings in a new report by business consultant Mckinsey & Company. That report, focusing on the pandemic in rural areas, calls for more at-home resources, including home testing, and the expansion of telehealth in rural communities. McKinsey found use of telehealth was 34% lower in rural areas than in urban ones. 

There have been other moves to expand HCBS and telehealth. Last week President Joseph Biden signed the American Rescue Act into law. The plan includes a temporary one-year increase in the Federal Medicaid Assistance Percentage (FMAP) to improve HCBS. Separately, the Medicare Payment Advisory Committee (MedPAC) earlier this week advised Congress to extend telehealth services through the end of the pandemic.