Biden Home Health Goals Come Up


June 30, 2021 11:17 am

A one-time infusion of cash for state home health programs will fund worker bonuses and training without meeting the Biden administration’s goal of bolstering wages and benefits in the industry, proposals in six states show. 

President Joe Biden has proposed injecting the home and community-based services industry with $400 billion, mostly through Medicaid. Biden wants to boost wages for home health workers—who currently make about $13 per hour, often without benefits—and cut down years-long wait lists for in-home care for the elderly and people with disabilities.

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Congress put a down payment on that plan earlier this year by offering states a one-year increase in the federal share of Medicaid dollars to expand their home care offerings under a February Covid-19 relief law (Public Law 117-2).

The plans outlined by six states — California, Colorado, Maine, Pennsylvania, Vermont, and Washington — show how state governments want to tap into the billions of federal dollars available to expand their Medicaid home and community-based care services but are limited by the temporary nature of the funding. The money could briefly help more Americans get home care, but won’t reach Biden’s larger goals for the industry.

“You balance a budget on things that are real, not on things that might happen,” Matt Salo, executive director of the National Association of Medicaid Directors, said. “You make plans for what’s real now.”

Groups that advise states on matters such as elder care say they expect almost every state to seek some of these funds this year. For lasting change, the plans suggest the larger home health package that Democrats aim to enact later this year must provide assurances to states that the money is permanent. 

Bonuses, Training

California is proposing one of the largest expansions in the nation — which it estimates would bring about $3 billion in new federal funds to the state. It wants to create a pilot program to train workers to serve people with Alzheimer’s disease and related dementia, as well as send a one-time $500 check to home-care workers who served patients for any three-month period in March to December of 2020, when Covid-19 cases rose significantly in the state.

California has been trying to expand training stipends for home-care workers as well, in hopes of countering what the plan calls “high turnover and staffing shortages” created by limited training and low compensation.

“We don’t have enough direct care professionals because people leave the field looking for a career ladder,” said Martha Roherty, executive director of the National Association of States United for Action in Aging and Disabilities, a coalition of state agencies that serve the elderly and people with disabilities. “With some training, you can look at the field as a place to make a career.”

Colorado plans to “supercharge” its existing home and community-based services by expanding eligibility. The state looks to take on projects such as short-term grants for behavioral health crises and transition services for people moving from institutions to their homes.

Pennsylvania is seeking $1.2 billion from the federal government to increase payment rates for some direct-care providers and to protect workers by purchasing personal protective equipment.

Washington plans to use the funds to improve access to home and community-based health services, Vermont wants to increase payment rates for some health-care providers, and Maine aims to put much of the new money into workforce stabilization. Those plans would all be in effect for one or two years.

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Long-Term Plans

Sen. Bob Casey (D-Pa.) introduced a bill recently to bridge these short-term funds with Biden’s pledged influx of a larger, longer federal investment.

Casey said he’s hoping states will lay some of the groundwork for his bill and, hopefully, generate support for the legislation.

“We’re already seeing enthusiasm for this,” Casey said.

Democrats will likely include the bill in a legislative package they plan to advance later this year using reconciliation, a procedure that requires only a simple majority in the Senate. All but 10 senators who caucus with Democrats support Casey’s bill, according to Casey’s office.