Home care workers could qualify for Medicaid covered health insurance and other benefits in a newly proposed rule by CMS.

According to CMS, the Reassignment of Medicaid Provider Claims Rule would enable states to make payments to third parties on behalf of home care workers, personal care assistants and other health care practitioners. These changes would make it easier for those workers to obtain and retain health insurance, training, and other employee benefits. If finalized, the rule would foster a stable and qualified health care workforce by making it easier for health care workers to access benefits that are typically only for full-time employees.

This rule, announced on July 30, 2021 and published on August 3, 2021, would allow Medicaid state agencies to make deductions from Medicaid payments due to certain individual practitioners in order to make payment to third parties on behalf of those practitioners for typical employee benefits, if the practitioner has consented to such deductions. This rule would apply to the class of individual practitioners for whom Medicaid is their primary source of revenue. Many of these workers provide home and community-based services for our most vulnerable individuals, enabling Medicaid beneficiaries to remain in their homes and communities. These changes would make it easier for these practitioners to enroll in, or pay for, customary employment benefits like health insurance and skills training. The rule would also help state Medicaid agencies by easing the administrative burden, while providing additional flexibility to operate their programs more efficiently and effectively.

This rule was developed in response to a 2020 U.S. district court ruling that vacated a 2019 final rule prohibiting states from making these types of payments to third parties. The newly proposed rule would reestablish this payment flexibility. State agencies not seeking to make these third-party payments on behalf of individual practitioners would not face any new administrative burden.

For more information and to read the proposed rule, please visit https://www.federalregister.gov/public-inspection/2021-16430/medicaid-program-reassignment-of-medicaid-provider-claims .