Debate: Should Medicaid Expand Home-Based Health Care Coverage?

Many states have now expanded their home-based and community-based services for Medicaid recipients. Still, many others have been reluctant to expand these state-level Medicaid home-based health care services.

Critics of expanding Medicaid home-based health care services argue that expanding these programs will encourage more individuals to enroll in Medicaid for long-term care coverage, which would expand the overall costs of administering Medicaid programs in these states.

We asked two professors and authors of ALM’s Tax Facts with opposing political viewpoints to share their opinions about how expanding Medicaid’s funding for home-based care services might affect Medicaid costs for states generally.

Below is a summary of the debate that ensued between the two professors.

Their Votes:

Bloink

Byrnes

Their Reasons:

Byrnes: It seems logical to assume that if Medicaid expands coverage for home-based care that a greater proportion of older Americans would be motivated to engage in asset decumulation strategies to qualify for Medicaid. When we expand this type of funding, it’s logical to assume that more older Americans will be pushed toward government-based elder care services, which of course would then increase overall costs of the program as a whole.

Bloink: There is absolutely no evidence to suggest that increasing government funding for home-based care would increase the rate of Medicaid enrollment or the general costs of the Medicaid program as a whole. In fact, there is evidence to suggest that expanding home-based care programs in general would actually reduce the costs of the overall Medicaid program in the U.S. because of the lower cost of home-based health care for older Americans.