Health Care Reform Requirements for Home Health Agencies

Health Care Reform Requirements for Home Health Agencies

In 2013, the Affordable Care Act (ACA) also known as Obamacare was authorized and began to be phased in.

Beginning in 2016, Employers with 50 or more Full Time Equivalents employers with 50 or more Full Time equivalent employees need to provide medical coverage to at least 95% of their full time employees or face penalties under the Employer Mandate.

In addition, the coverage has to be “affordable” for employees using the 9.5% rule, where an employees cost cannot exceed 9.5% of their gross wages.

For example, if an employee earns $12/hr and works 30 hours per week (Full time) their cost for insurance cannot exceed $34.20/week or $136.80 per month or it is not considered “affordable”.

If the actual cost of the health benefit is $500/month, the company must pay at least $363.20 or 73% of the premium in order to be “affordable”. If the cost of the health benefit is greater than $500 per month the % increases.

If any employer had 50 Full Time employees under this scenario, their cost would be $18,160/month or $217,920/year just for health benefits! Eek!

However, failure to provide this coverage may result in fines of up to $3000 per employee! EEK!

So, why is this important to home health clients?

It’s important to understand changes that effect the caregivers providing care to clients.

Home Health Agencies are working hard to provide the best possible caregivers to clients in the home. Oftentimes, clients have no reason to understand the various regulations that effect their care.

In the case of Home Health Care, there are still unknown costs that may contribute to increased charges as the underlying costs of the Affordable Care Act become more apparent.

It is important for clients to understand the changing environment of home care so that they can better work with their Home Health Agency to ensure the best care possible for their loved ones.