Navigant Healthcare Pulse Article Series
As part of an ongoing effort to decrease federal expenditures over a 10-year period (2014 - 2024), President Obama’s FY 2017 Budget Request includes several program integrity-related proposals designed to reduce fraud, waste and abuse (FWA). Among other proposals, the budget calls for the expansion of state Medicaid Fraud Control Unit (MFCU) investigation authority to home- and community-based services (HCBS). In the long-term care arena, MFCU’s authority extends to Medicaid-funded healthcare facilities, such as nursing homes, and to “board and care” facilities, such as assisted living facilities, which may or may not be funded by Medicaid. This budget request would extend federal matching funds for state MFCUs to investigate and prosecute abuse and neglect in non-institutional settings, such as HCBS.
This budget request comes at a time when state governments have been challenged with rising costs of long-term supports and services (LTSS). To address such challenges, states are placing greater emphasis on the development and implementation of quality measures to improve LTSS delivery and quality, while monitoring access to care and outcomes. Most individuals in need of LTSS want to live in their own homes and communities, and states are working to accommodate these preferences by increasing access to HCBS for low-income populations. In addition, this budget proposal to decrease Medicaid expenditures is accompanied by proposals that would increase spending for certain HCBS services through, for example, expansion of eligibility for HCBS services for certain categories of individuals.