Senator Bob Casey and then-Vice President Joe Biden on February 10, 2015 in Washington, DC. [+] (AFP/MANDEL NGAN/Getty Images)
Getty Images/AFP/AFP/AFP/AFP/AFP/AFP/AFP/AFP
President Biden announced last week that he would abandon his proposed $400 billion increase in the federal share of Medicaid’s home-based long-term care services. He made the concession in order to clinch an agreement on a far bigger physical infrastructure measure with a bipartisan group of 21 senators. However, the current system of supports and services for older adults and young people with disabilities continues to have significant problems in the aftermath of the pandemic. What is the status of long-term care reform now? A scaled-back version of Vice President Joe Biden’s $400 billion increase in Medicaid home and community-based services (HCBS) is still possible. Biden and a number of congressional Democrats have maintained that the proposal will be included in some form in a large domestic spending package that Congress is expected to examine this fall.
This is the bill the Democrats are hoping to approve on a party-line vote using the arcane Senate budget reconciliation rules. While some important Republicans privately recognize the need for greater HCBS financing, it is unlikely that any of them will vote in favor of it. Especially since Biden and Hill Democrats propose to fund it and other features in part by raising corporate taxes, something congressional Republicans vehemently oppose.
So, what’s next?
Nonetheless, that bill, which is expected to contain some sort of paid family leave, could garner support from 50 Senate Democrats, including some of the party’s more conservative members, such as West Virginia Senator Joe Manchin.
But how might it appear?
Take a look at the Better Care Better Jobs Act, which was filed late last week by Senate Aging Committee Chair Bob Casey (D-PA). Importantly, the bill has already received the support of 40 Senate Democrats, including Finance Committee Chairman Ron Wyden (D-OR) and Democratic Leader Chuck Schumer (D-NY). Rep. Debbie Dingell (D-MI) filed a similar bill in the House.
ADDITIONAL INFORMATION FOR YOU
The measure would improve administrative money to help states grow their HCBS programs while also permanently increasing the federal contribution to Medicaid HCBS by ten percentage points.
States could increase their federal match by expanding Medicaid HCBS eligibility, requiring coverage for personal care services, expanding supports for family caregivers, adding information services, better coordinating Medicaid HCBS with housing, transportation, and employment programs, and raising pay and benefits for home care workers, among other things.
Rather than simply replacing state funds, the federal funds would be used to expand programs.
How daring are you?
The bill is less ambitious than an earlier draft circulated by Casey and Dingell last spring. States would have been obligated to make home-based care available to Medicaid clients in the same way that nursing home care is required today. However, policy experts questioned whether governments could provide such care without first developing a broader set of services required for a successful home-based program.
HCBS benefits are not mandated by the Casey-Dingell law, but it is an effort to build out the infrastructure.
There’s a fair probability Democratic leaders will try to tack this on to a larger reconciliation bill aimed at families. Even in this scaled-back form, it’s unclear whether conservative Democrats like Manchin will find it too ambitious. West Virginia, on the other hand, has one of the largest percentages of low-income elderly individuals in the country, as I’ve previously stated. About a third of the city’s citizens over the age of 65 are on Medicaid. As a result, Manchin should be intrigued.
Democrats have a long list of demands for the reconciliation package, which may possibly be the final major piece of legislation they can enact before the 2022 elections. Expanding public health care, education, and a wide range of safety net services are all part of the plan. The battle for funds will be fierce.
Long-term care insurance provided by the government
To earn the support of conservative Democrats, party leaders may need to keep the bill’s overall size under $2 trillion. And it will need a reduction in Medicaid HCBS expansion. My best guess is a $200 billion rise in federal spending over the next ten years.
While the most of the attention will be on the Medicaid HCBS expansion and family leave, Rep. Tom Suozzi (D-NY) is about to present legislation to establish a public, catastrophic long-term care insurance program. It’ll probably be similar to a bill offered by House Energy and Commerce Committee Chair Frank Pallone (D-NJ) in 2018 and a 2016 proposal by the Long-Term Care Financing Collaborative.
That bill will be far more difficult to pass than Medicaid expansion. It does not have the White House’s or legislative leadership’s support. It will very certainly be funded by a broad-based tax increase, and Biden has stated that any tax increase on individuals earning less than $400,000 would be opposed.
Suozzi’s bill, on the other hand, could kick-start a congressional debate over how to increase money for long-term supports and services for the roughly 8 million Americans who need help but aren’t poor enough to qualify for Medicaid.
This year, we’re still a long way from meaningful long-term care change. However, don’t rule it out just yet./nRead More