New Legislation Would Boost Medicaid Funds for HCBS

Washington, D.C.—A new bill has been introduced in Congress that would increase Medicaid and state funding for home- and community-based services (HCBS) and provide resources to states for the caregiving workforce. 

Supporters say the HCBS Access Act would, over time, eliminate lengthy waiting lists for homecare services.  

“The caregiving crisis in this country leaves millions of seniors and people with disabilities without a meaningful choice of where they can receive essential, life-sustaining care,” said U.S. Senate Special Committee on Aging Chairman Bob Casey, who introduced the bill in the Senate while he held a hearing on ways to support senior care. “It corners many family caregivers into upending their careers and living on poverty wages or performing unpaid work because they have no other options. This is not the way that a great Nation treats seniors and families. It is time we make the smart economic investment in home and community-based services. MyHCBS Access Act would provide seniors and people with disabilities with a real and significant choice between receiving care in a long-term care facility or at home, where so many of them wish to stay, and ensure that paid caregivers can turn poverty jobs into family-sustaining jobs.” 

U.S. Rep. Debbie Dingell introduced companion legislation in the House.

Casey’s hearing, “Uplifting Families, Workers, and Older Adults: Supporting Communities of Care,” examined the economic benefit of investing in Medicaid HCBS. Millions of seniors and people with disabilities nationwide rely on caregivers to provide everyday services like help with bathing, eating, and managing medications. The caregivers providing these life-sustaining services often live in poverty; direct care workers earn a median wage of roughly $14 per hour. In a release, Casey’s office said investing in home care would address the decades-long workforce shortage crisis, allow family caregivers to return to their careers and help raise wages and improve benefits for caregivers, which would boost economic activity and consumer spending.

While the majority of seniors and people with disabilities have reported a preference for receiving care at home, they may be forced to live in an institutional setting just to access the services they need, due to long wait lists. The HCBS Access Act would put home care on equal footing with long-term care facilities under Medicaid, ensuring eligible older adults and people with disabilities have a real choice of care and support options.

People eligible for Medicaid long-term services and supports (LTSS) are offered immediate access to nursing homes or other institutional settings. However, if they want to remain in their homes with the help of Medicaid HCBS, they are often put on a waiting list and can wait years or even decades for direct care services as Medicaid will not pay for home care unless a waiver has been granted. Because so many people are on waiting lists for Medicaid HCBS, most long-term care is provided by family, and most family caregivers are unpaid. The average family caregiver spends over a quarter of their income on caregiving activities and many must forgo promotions or work reduced hours in order to provide care.

Earlier this year, Casey introduced the Better Care Better Jobs Act, which would enhance Medicaid funding for home care services. This bill would strengthen the caregiving workforce, improve quality of life for families, and boost the economy by creating good-paying jobs to make it possible for families and workers alike to thrive economically.

Casey invited Jacinta Burgess, a homecare worker from Harrisburg, Penn., to testify at the hearing about her experience caring for her mother full-time.

“So many homecare workers take on second or third jobs to earn more income, but I’m unable to work outside my home due to the care my mother requires,” Burgess said. “It’s not safe for her to be on her own for too long… Now, I am my mother’s eyes, ears, mouth, hands and feet.

“A severe shortage of home care workers forces many working families to choose between caring for a loved one and a paycheck,” Burgess continued. “Just like me, working people are too often forced to leave their jobs or stop working entirely when the need for care arises in their family. Oftentimes, it’s because they can’t afford the cost of care, or in some communities, there aren’t enough caregivers or resources to meet their needs.”

The HCBS Access Act is cosponsored by U.S. Sens. Maggie Hassan (D-NH), Sherrod Brown (D-OH), Tim Kaine (D-VA), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Peter Welch (D-VT), John Fetterman (D-PA), Jeff Merkley (D-OR), Bernie Sanders (I-VT), Tammy Baldwin (D-WI), Tammy Duckworth (D-IL), Elizabeth Warren (D-MA), Jack Reed (D-RI), Edward Markey (D-MA), Jeanne Shaheen (D-NH), and Patty Murray (D-WA).

Read more about the HCBS Access Act here.

Read more about the Better Care Better Jobs Act here.