HCBS Funding Is Now in the Congressional Crosshairs

The $400 billion that the Biden administration wanted for strengthening the nation’s home- and community-based services (HCBS) infrastructure is likely in the crosshairs of Congress.

Currently, President Joe Biden and senior Democrats are working to figure out what’s included in the large spending legislation they hope to pass through the budget reconciliation process. Early estimates had a $3.5 trillion package touching on health care, education and climate change.

In order to pass the domestic investment plan via reconciliation, Democrats need the support of their entire party in the Senate. Yet some Senators, including Joe Manchin of West Virginia, have expressed a desire to get the spending legislation closer to $1 trillion to $1.5 trillion.

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“Instead of rushing to spend trillions on new government programs and additional stimulus funding, Congress should hit a strategic pause on the budget-reconciliation legislation,” Manchin wrote in a recent Wall Street Journal op-ed. “A pause is warranted because it will provide more clarity on the trajectory of the pandemic, and it will allow us to determine whether inflation is transitory or not.”

In addition to the package’s overall price tag, Machin has expressed specific concerns about the plan to spend hundreds of billions of dollars on in-home care, according to a Tuesday report from Axios.

Other members of Congress have pushed back against investments in “soft” infrastructure as well.

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Due to the lack of full-party support at the moment, funding for HCBS, which would likely be carved into the spending legislation through the recently introduced Better Care Better Jobs Act, may end up closer to $150 billion. Sens. Bob Casey of Pennsylvania and Ron Wyden of Oregon are among the key backers of the Better Care Better Jobs Act, along with Rep. Debbie Dingell of Michigan in the House.

Another Axios report from Friday said the House Ways and Means Committee was looking to invest $190 billion into HCBS.

Even if $400 billion is ultimately reduced to $190 billion, that would be a historic increase for HCBS providers, which for years have struggled with lackluster Medicaid rates and dire labor shortages.

Additionally, some reports suggest the pool of money for HCBS may be stretched a little further.

“Supporters have been working on leaders in both chambers to raise that number,” the HuffPost reported Wednesday. “Several have told HuffPost that Senate leadership has indicated a willingness to go to $200 billion, maybe even $250 billion, while House leadership has been more reluctant to go beyond the $150 billion.”

Working in favor of HCBS funding are macro-demographic trends. Over the next 10 years, the population of U.S. adults 65 and older is projected to skyrocket from 49.2 million to 94.7 million.

If Congress doesn’t proactively offer a boost to HCBS providers and the home care workforce now, it’ll be forced to do so in the not-so-distant future.

Originally, the $400 billion for HCBS was meant to expand state Medicaid programs, allowing them to roll out more home-based care solutions for seniors. It was also supposed to help providers lift their wages, as the median annual earnings for home care workers is about $18,100, according to PHI data.

“This workforce is still facing the long list of challenges that we’ve studied in the past,” Stephen McCall, a PHI data and policy analyst, previously told Home Health Care News. “This workforce is in extremely high demand, driven primarily by the growing population of older adults. We’ve seen this workforce add millions of jobs over the past decade, and we can expect a million more in the next decade — more new jobs than any other occupation.”

Directly funding HCBS isn’t the only home-based care policymaking item on Congress’ to-do list, though.

For starters, Medicare-reimbursed providers have urged Congress to waive 4% cuts to Medicare payments that will go into effect next year. At the same time, they’re asking the government to keep in place temporary telehealth flexibilities enacted amid the public health emergency.

Finally, there’s also the Choose Home Care Act of 2021 to consider. If passed into law, the bill — designed to create more in-home care options for seniors following a hospital stay — would save $247 million annually, according to home health industry estimates.

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