WASHINGTON, DC – Rep. David Schweikert, R-Ariz., yesterday introduced the Combating Deceptive Practices in Assistance Programs Act, H.R. 7713, to tighten Medicaid personal care eligibility and protect resources for patients who truly need hands-on help with basic daily tasks.

The bill amends Title XIX of the Social Security Act so that, to qualify for Medicaid personal care services, an individual must be unable to perform three or more activities of daily living (ADLs), as defined in Section 7702B(c)(2)(B) of the Internal Revenue Code. It also makes clear that instrumental activities of daily living (IADLs), such as managing money or doing routine household chores, do not count toward that threshold.

“Medicaid personal care is supposed to be for the person who cannot safely bathe, dress, move or feed themselves without another set of hands,” Schweikert said. “When you start leaning on fuzzy checklists instead of clear medical need, the spending explodes and the people who truly cannot get through the day on their own end up fighting for space in the line.”

Since 1994, state Medicaid plans have used authorities such as Sections 1905(a), 1915(c), 1915(d), 1915(j) and 1915(k) to provide at-home services that help beneficiaries stay in the community instead of entering nursing homes. In New York’s Consumer Directed Personal Assistance Program, enrollment has climbed above 250,000 people and now costs taxpayers roughly $6 billion per year, with some estimates as high as $11 billion.

“Taxpayers were told these programs would keep the most vulnerable out of institutions and closer to their families,” Schweikert said. “If the test turns into errands, bill-paying or light housekeeping, you blur that promise and create an easy avenue for abuse. A three-ADL standard puts a basic guardrail back in place so personal care is tied to serious functional limits instead of convenience.”

ADLs are core self-care tasks such as bathing, dressing, toileting and continence, eating and safely moving between a bed, chair or toilet. IADLs cover more complex tasks that support independent living, including managing finances, transportation, communication, meal preparation and household management.

Under the Combating Deceptive Practices in Assistance Programs Act, Medicaid personal care services would be reserved for beneficiaries with clear, documented ADL needs rather than looser IADL-based criteria. The goal is to keep home-based care available for individuals with significant impairments while reducing the risk that broad state waivers turn personal care into a wide-open benefit that crowds out patients with the highest needs.More information on the bill can be found here.