While MA Penetration Grows, Plans Continue to Underpay Providers, Home Care Advocates Say

McKnight’s Home Care | By Adam Healy
 
As Medicare Advantage continues to dominate total Medicare enrollment, home care providers face mounting reimbursement challenges and improper service denials that constrain their ability to care for patients, they argue.
 
On Tuesday, healthcare research and advisory services firm ATI Advisory released its 2024 Medicare Advantage Enrollment Databook, an up-to-date snapshot of the Medicare enrollment landscape. It found that MA penetration has tipped above 50% in more than half of the states in the United States, and private plans’ membership growth has shown no signs of stopping.
 
While MA enrollment increases, the number of Medicare fee-for-service beneficiaries has actually been on the decline, according to the report. MA enrollment grew at an annual rate of roughly 7% in the past year, adding about 2.2 million new members between 2023 and 2024. During the same period, traditional Medicare lost about 2% of its population, or roughly 700,000 members.
 
As many as 10 million new members are projected to join MA plans by 2031, which would put MA penetration closer to 55%, according to the report.
 
Meanwhile, home healthcare stakeholders have been raising concerns that MA plans’ cost-management strategies and stingy reimbursement rates have hindered patients’ access to quality care. Just last week, LeadingAge representatives sent a letter to Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure pointing out some of these very concerns.
 
“MA plan contracted rates with SNFs (skilled nursing facilities) and HHAs (home health agencies) have been, at best, 60-80% of what these providers would have been paid under traditional Medicare,” Nicole Fallon, vice president of integrated services and managed care at LeadingAge, wrote in the letter. “In addition to plans paying providers inadequately, MA plans have added layers of administrative burden onto these providers … In other words, providers are being asked to do more and being paid less.”
 
Many home healthcare providers have had to hire additional staff to handle administrative burdens such as prior authorization requests or unintuitive MA claims processes, Fallon roted. And though Medicare-eligible patients are increasingly aligning themselves with MA plans, MA’s flaws ultimately reduce their access to good home healthcare.
 
“Arguably, some MA plans are not delivering on the basic requirements today of ensuring beneficiaries have access to core Medicare A and B services,” Fallon wrote. “While the MA program offers benefits above traditional Medicare … the cost of inadequate provider payments and improper care denials and terminations for beneficiaries is proving to be too high a trade-off.”
 
In a McKnight’s Newsmakers podcast last month, Fallon and Mollie Gurian, VP of home-based public policy for LeadingAge, talked about how CMS must continue to challenge MA plans to narrow prior authorization decision-making times, improve access and ensure fair payment adequacy to providers.