Updated April 19, 2021 at 10:00 a.m. CDT, to include quote from AAHomecare.

WASHINGTON, D.C. (April 1, 2021)—Industry advocates are lauding President Joe Biden's newly-released infrastructure plan, which includes $400 billion dollars for home- and community-based care for seniors and people with disabilities; it would also increase wages for in-home caregivers. 

Biden included efforts to improve the lives of homecare workers and those receiving care in the $2 trillion package, along with efforts focused on highways, bridges, transit systems, water supplies, the electrical grid and more. 

“These investments will help hundreds of thousands of Americans finally obtain the long-term services and support they need, while creating new jobs and offering caregiving workers a long-overdue raise, stronger benefits, and an opportunity to organize or join a union and collectively bargain,” a White House fact sheet reads. 

During his presidential campaign, Biden said he would devote $450 billion to allow more older Americans and their families to receive care at home or in their communities, as opposed to nursing homes and other institutions.

“The president’s support for homecare is a monumental advance in the decades-long effort to provide full access to health care outside of an institution,” said the National Association for Home Care & Hospice in a statement. “This effort deserves the complete support of the Congress and the American public. It is time we honor our parents and grandparents with the opportunity to age in place and to provide full access to the least restrictive health care environment for persons with disabilities. The benefits of homecare are long established. We all should work to remove any barriers to homecare, including unnecessary care waiting lists and insufficient caregiver compensation. The caregivers should be given the high respect they deserve along with fair compensation for the essential services they provide.”

"The White House's bold announcement is in line with CareAcademy's mission and what we are seeing as a result of COVID's impact: more Americans and older adults want greater choice in their care settings, and increasingly home and community is the preferred choice. We see a tremendous opportunity to leverage and skill the home and community workforce to ensure that Americans receive quality healthcare and this effort ensures that America is able to meet the need not just now but for generations to come. We fully support the stated intention to work to solve the artificial wage ceiling created by reimbursement rates. This will be a game-changer for an industry in desperate need of quality talent to fill open roles and transform the direct care workforce," said Helen Adeosun, Founder and CEO, Care Academy.

“The homecare workforce has been undervalued and under-appreciated for far too long. PMHC is encouraged by the Biden Administration’s recognition of the value of the home care workforce and the proposed efforts to improve access to, and the quality of, home and community-based home care services,” said David J. Totaro, chairman of the Partnership for Medicaid Home-Based Care(PMHC) "It is more important than ever to invest and expand our country’s capacity for home and community-based services as our aging population is growing exponentially and the strong outcomes of these home-based services have become ever more evident during the pandemic.”

"We’re pleased to see that the Biden Administration is recognizing the need for a stronger investment in home-based care.  The value of home medical equipment and caregiving in the home has never been more evident than it has been during the COVID-19 pandemic, and the need for increased access to quality HME is only going to become more important as the population of older Americans continues to grow," said AAHomecare President and CEO, Tom Ryan. "We [or AAHomecare] will certainly seek out opportunities to include provisions that strengthen access to HME as part of any legislation that comes forward from the home health infrastructure proposal.  However, our main focus will be continuing to press CMS and Congress to adopt Medicare reimbursement policies that reflect the rising product costs and significant operational challenges HME suppliers are facing."

According to the White House, the proposal announced March 31 would expand access to home- and community-based services (HCBS) under Medicaid and extend the Money Follows the Person program. 

"President Biden believes more people should have the opportunity to receive care at home, in a supportive community, or from a loved one," the fact sheet reads. 

That expansion would also boost wages and benefits for caregivers and give them the opportunity to unionize.

"This will improve wages and quality of life for essential home health workers and yield significant economic benefits for low-income communities and communities of color," the fact sheet reads.Congressional action is needed on the American Jobs Plan before these changes can go into effect. There are currently bills active in Congress addressing these issues. Most recently, Sen. Bob Casey (D-Penn.) and Rep. Debbie Dingell (D-Mich.) introduced 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.