President Biden is planning to make good on his promise to “solidify the infrastructure of our care economy.” In addition to investments in the power grid, broadband access, and traditional infrastructure like roads and bridges, the President vowed to invest in healthcare and senior care. In that vein, a bicameral group of federal legislators introduced the Better Care Better Jobs Act, a bill that would allocate billions of dollars into home and community-based care services (HCBS) over the next few years. The bill is meant to expand upon the $12.7 billion short-term HCBS funding already passed as part of the American Rescue Plan. All told, the bill proposes a $400 billion investment in HCBS nationwide.

Medicaid Expansion and HCBS Access

The intent of the bill, sponsored by Democratic U.S. Senators Bob Casey of Pennsylvania and Ron Wyden of Oregon, as well as U.S. Rep. Debbie Dingell of Michigan, is to expand access to quality healthcare for seniors and people with disabilities. In addition, the proposal would prioritize wage and benefit increases for the people who provide HCBS.

Among the various provisions, the bill would enhance Medicaid funding for HCBS services. Under the Act, states would become eligible for a permanent ten percentage point increase in federal Medicaid matching for providing HCBS, and enhanced funding for administrative costs associated with improvement efforts. States would be required to cover personal care services, expand eligibility criteria to cover more patients and provide for a wider range of services, and adopt programs better able to navigate long-term care systems.

Advocates Point to an Urgent Need for the Law

Sponsors and advocates of the bill argue that the investment is sorely needed. The country’s existing HCBS infrastructure is underfunded and fragmented, the consequences of which have been especially noticeable during the COVID-19 pandemic. The proposal is, in part, a response to the disproportionate effect the pandemic has had on people in nursing homes and other group living settings.

Problems with a lack of community-based care have existed since well before the pandemic, yet HCBS providers have historically struggled to recruit enough workers to meet the increasing demand. As more Americans age into long-term care, without sufficient insurance to cover their healthcare costs, HCBS workers are offered low wages, inadequate benefits, little training, and limited opportunity for advancement in a grueling, emotionally-taxing industry. The HCBS workforce is also disproportionately composed of female workers, low-income earners, and people of color. Improving HCBS wages and benefits is also about encouraging equality in the workforce.

The Act seeks to remedy this problem by not only building out HCBS infrastructure and expanding self-directed services but also by expanding wages and benefits for HCBS workers. The aim is to make HCBS work competitive with other positions. As a condition of receiving the increased funding, states would be required to implement systems designed to promote HCBS services, including by increasing HCBS worker pay rates and regularly updating HCBS pay rates based on public input. States would be required to submit to oversight and monitoring concerning their satisfaction of the Act’s goals in order to continue receiving the added funding.

The Act would also incorporate spousal-impoverishment protections and make permanent the “Money Follows the Person” program, which is meant to help patients transition out of long-term care facilities back into home care.

The Economic Impact

Caring Across Generations and the National Domestic Workers Alliance estimate that the bill would create more than 1.1 million jobs and generate around $40 billion a year in new income, more than paying off the cost of the bill in a relatively short period.