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Council hears federal momentum for Medicaid coverage of community‑based palliative care
Summary
Council member Eugene briefed the advisory council on recent CMS signals and state examples (Hawaii, New Jersey) that show a path for Connecticut to add community‑based palliative care via a Medicaid state plan amendment; he urged the council to consider joining a six‑state cohort to complete benefit design by late 2027–early 2028.
Eugene told the Palliative Care Advisory Council that the federal Centers for Medicare & Medicaid Services recently issued a notice of rulemaking that could allow community‑based palliative care to be billed under a Medicare home‑care benefit, creating a favorable environment for states to expand Medicaid coverage.
"CMS put out a notice of rulemaking a couple of weeks ago, looking at a Medicare home care benefit in which essentially it's a billing clarification that says that, you know, community based palliative care can be slotted under that rubric," Eugene said. He cited two states that have used state plan amendments (SPA) to add community‑based palliative care—Hawaii in 2024 and New Jersey (benefit went live April 1, 2026)—and described a no‑cost, three‑year grant from the Aleah Institute that funds Tori Fields/TFA Analytics to prepare SPA documentation for a six‑state cohort.
Eugene summarized three concerns Connecticut officials raised—whether cost‑savings can be shown within Connecticut's two‑year budget cycle, administrative burden (especially for DSS) and potential federal pushback under HR 1—and said comparator states demonstrate cost neutrality or savings within about a year. He recommended the council consider advocacy and data‑sharing to support the state’s participation in the cohort and noted that any work by TFA Analytics would require state data sharing and likely conclude with recommendations by the end of 2027 or early 2028.
