What Will Happen to Home Care Under the Trump Administration?

Published January 16, 2017

The Trump Administration and new Congress are likely to deliver a mixed bag to the home health field. Some targeted policy changes may directly benefit home care, while the broader agenda includes areas of concern. But even if legislative change is rapid, it may be years before the impact is felt on the ground.

On the plus side, both major parties’ platforms mention home care in a positive light. The Republican platform states, “Because most seniors desire to age at home, we will make homecare a priority in public policy…” Meanwhile, President Elect Donald Trump’s choice for Health and Human Services Secretary, Tom Price is a leading foe of the newly instituted Pre-Claim Review, a prior authorization requirement for Medicare home visits, which has had a rocky rollout. Home care agencies have complained vehemently that the requirement is costly and difficult; they can expect their cries to be heard and acted upon.

Trump campaigned on a promise not to touch Medicare, but Republicans in Congress are eager to make changes. Since the election Trump has shifted his stance and now favors “modernization.” Initially that could mean that Medicare Parts A and B are combined, and that co-pays are introduced for home care services, where currently none exist. Eventually, a voucher system might be imposed that would require beneficiaries to purchase coverage in Obamacare style exchanges.

There are other healthcare, economic and immigration policies that are likely to shape the industry.

  • Value based care such as bundled payments and Accountable Care Organizations have encourage the use of home care. If this approach is de-emphasized, which appears likely, there may be less demand for home health.
  • About 28 percent of home health workers in the US are foreign born, and the industry had expected their share to grow as the population ages. Strict immigration laws and hostility toward those born abroad can be expected to affect the availability of workers.
  • The imposition of tariffs on foreign made goods used in home care such as disposable supplies and durable medical equipment (DME) could raise costs.
  • The drive for a $15 federal minimum wage is headed nowhere fast, but state and municipal level initiatives will affect the home care industry nonetheless. Agencies may be caught between rising wage costs and stagnant reimbursement rates. On the other hand, the implementation of stricter rules on overtime is stalling.

Home care won’t drive the healthcare policy agenda, but whatever happens will have a significant impact on the industry. Republican leaders are currently discussing a strategy of repealing the Affordable Care Act but then waiting at least two years before implementing significant changes. That means real change could be kicked down the road, and could be affected yet again by the results of the mid-term elections.