CMS Releases Guidance on Direct Care Worker Reporting Requirements for HCBS
On October 9, the Centers for Medicare and Medicaid Services (CMS) released both a State Medicaid Director Letter (SMDL) and Technical Specifications to states. The guidance relates to provisions from the Medicaid Access Rule which required states, among other requirements, to collect data and report to CMS on wages and benefits paid to direct care workers providing homemaker, home health, and personal care services. States must be prepared for the reporting requirement beginning July 9, 2028 and the reporting of readiness to CMS by July 9, 2027. With that in mind, CMS issued the SMDL and technical specifications to help states establish their infrastructure for collecting data and reporting to CMS.
The SMDL contains useful examples to help states consider how to establish reporting infrastructure and rate attribution, along with reminders that IT system upgrades are available for enhanced federal funding
2027 MA Landscape is Shifting with Open Enrollment Starting Oct. 15
Medicare Annual Open Enrollment begins Thursday, October 15. This is the time Medicare beneficiaries can examine their options for how to receive their Medicare benefits including Medicare Advantage, Part D plans, traditional Medicare and/or Medigap plans. Check out Medicare Open Enrollment 2027: What You Need To Know for more information about Medicare Annual Open Enrollment and how your organization may be able to help those you serve with these critical decisions.
Based upon the 2027 MA plan offerings, it is projected that as many as 4.5 million beneficiaries will need to make a new plan selection because their current MA plan is not being renewed. Analysts indicate that plans are increasing out-of-pocket costs for their enrollees who access care and reducing benefits for 2027 even if premiums may be remaining steady. Check out 2027 Medicare Advantage Changes: Lower Premiums, Higher Stakes. for more details on what is changing and potential impacts for beneficiaries and providers.
Finally, the MA plan Star Ratings have been published for 2027 and will be included on Medicare Plan Finder. While plans have improved on some key metrics related to readmissions and care transitions, overall star ratings have declined. For plans receiving less than 4 stars, this will translate into lower revenue and potential lost enrollment. With fewer dollars, we expect plan contract and reimbursement discussions will still be difficult in the coming year. Check out 2027 MA Star Ratings Released: Why It Matters for Providers to prepare for these discussions.
Workforce Bill Aimed at Direct Care Workers Introduced
On October 1, House Committee on Education and Workforce Ranking Member Bobby Scott (D-VA), along with Representatives Adelita Grijalva (D-AZ) and Susie Lee (D-NV), introduced the Direct CARE Opportunity Act of 2026. This legislation is intended to strengthen the direct care workforce through federal investment in recruitment, retention, training, and career advancement initiatives. The proposal builds on concepts that have circulated in previous congresses and reflects ongoing concerns about growing demand for direct care workers and persistent workforce shortages across aging and disability services.
The bill’s central concept is the establishment of a grant program administered by the Department of Labor, in coordination with the Department of Health and Human Services, to support strategies for recruiting, retaining, and advancing direct care workers. Grants would be awarded for a minimum of five years to support workforce development initiatives such as education and training programs, apprenticeships, supportive services, and other efforts designed to strengthen the direct care workforce. Potential applicants for such grants would include states, workforce boards, labor organizations, nonprofit organizations with expertise in aging or disability services, institutions of higher education, tribal organizations, and other entities capable of developing and implementing direct care workforce strategies. The bill is largely agnostic on care setting and specifically identifies personal care aides, direct support professionals, home health aides, and nursing assistants among the workers it is intended to support.
