Members of Congress Push for More HCBS Funding

WASHINGTON, D.C. (February 16, 2021)—With the next COVID-19 relief package currently under development and possibly coming with a significant price tag—upwards of $1.9 trillion as requested by the Biden administration—many elected officials and stakeholder groups are proposing increased funding to Medicaid home and community-based services (HCBS).

Similar proposals have been made in earlier versions of COVID-19 relief. Notably the CARES Act, passed into law in March of 2020, contained a 6.2% increase in the Federal Medical Assistance Percentage (FMAP), the federal share of the Medicaid program provided to the states. Subsequent legislation and proposals called for additional increases.

Most recently, Sen. Bob Casey (D-Penn.) and Rep. Debbie Dingell (D-Mich.) introduced legislation, the COVID HCBS Relief Act (S. 151, H.R. 525), which would provide an additional 10% to the federal share of the FMAP through the end of the public health emergency (PHE). Funds provided by this increased federal share could be used for:

• Increased payment rates to home health agencies and agencies that employ direct service professionals;
• Paid sick, paid family, and paid medical leave;
• Provide hazard pay, overtime pay, and shift differential pay;
• Provide HCBS to individuals currently on a waitlist;
• Expand HCBS through reduction of institutional setting census;
• Purchase emergency supplies, such as personal protective equipment;
• Pay for travel of home health workers; and
• Recruitment and training of new home health and direct service professionals.

Following the conclusion of the PHE, funds could be used in several ways relating to HCBS, including transitioning individuals back to their homes and resumption of HCBS.

The National Association for Home Care & Hospice (NAHC) supports this legislation and advised on its development. Meanwhile, the House Energy and Commerce Committee held a markup on legislation that would increase the FMAP by 7.35% from April 1, 2021 through March 31, 2022. It is likely this version is what is included in the COVID-19 relief package. While a smaller FMAP rate, it still allows funding for HCBS in the same ways as does Sen. Casey and Rep. Dingell’s legislation.

In addition to introducing this legislation, Sen. Casey joined with Sen. Booker (D-N.J.) and 29 of their colleagues in sending a letter to the Biden administration encouraging investment in HCBS consistent with President Biden’s American Rescue Plan and Build Back Better agenda.

In their letter, the senators call out many benefits of such a move. “As a critical component of your Build Back Better Plan, this investment in HCBS would create a robust caregiving system, while also driving sustainable economic growth and meeting the health care needs of our nation’s rapidly aging population. It would help propel the country’s economy out of the pandemic-induced recession by increasing employment and enabling those receiving services to participate in their communities. It would transform low-paid caregiving jobs into family-sustaining occupations with higher wages, benefits and the opportunity to join a union. These outcomes would also advance racial and gender equity, given that the caregiving profession is disproportionately supported by Black women, other women of color and immigrants. Finally, such an investment would support people with disabilities, older adults and family caregivers with the supports they need to live the lives they wish to lead.”

In addition to advising on the development of the legislative language, NAHC joined with the Disability and Aging Collaborative, a coalition of approximately 40 organizations focused on advancing long-term services and supports at the federal level, in sending a letter urging congressional leaders to include the COVID HCBS Relief Act in the package currently under development.

NAHC will continue to work with the Congress and other interested stakeholder groups in advocating for increased Medicaid funding and a continued efforts towards further rebalancing of Medicaid spending in favor of HCBS.