The Medicaid 80/20 Rule Calculator helps home care agencies evaluate the impact of the Medicaid Access Rule (CMS-2442-F) on profitability. By inputting your state's Medicaid rate, caregiver wages, and monthly Medicaid hours, you can assess how the 80/20 rule will affect your profit margins. This tool provides insights but is not a substitute for legal or billing advice.
You can also use this tool for advocacy efforts. For example, use the results to bolster your advocacy by presenting your findings to your local representatives and asking them to help or support legislation like Cammack's HR 8114, which seeks to block the Medicaid 80/20 rule. You can find your local representatives here.
Here's how to use the tool and understand the results:
- Inputs
- State: Select your state from the dropdown menu.
- Medicaid Rates: Prefilled with your state's median Medicaid rate. Adjust this field if you receive a different rate.
- Current Caregiver Payment: Prefilled with your state's minimum wage. Adjust this field to match what you actually pay your caregivers.
- How Many Medicaid Hours Do You Do Per Month: Enter the number of hours your agency provides to Medicaid clients per month.
- Results
- Current Caregiver Payment as a % of Reimbursement Rate: The percentage of your reimbursement rate currently allocated to caregiver payments.
- Current Profit Margin: Your current profit margin percentage based on the existing caregiver payment rate.
- Profit Margin Change Due to the Mandate: The projected change in profit margin percentage if the new rule takes effect.
- Your Current Profit: Your current profit in dollars per hour and per month.
- Caregiver Payment After Mandate Takes Effect: The projected caregiver payment rate in dollars per hour and per month when the rule takes effect.
- Caregivers Wage Change Due to Mandate: The projected change in caregiver wage in dollars per hour and per month when the rule takes effect.
- Profit After Mandate Takes Effect: The projected profit in dollars per hour and per month when the rule takes effect.
- Profit Difference: The change in profit in dollars per hour and per month when the rule takes effect.
