While Other Home-Focused Legislation Waits, Better Care Better Jobs Act Gets New Life

Lawmakers are hoping for success the second time around. On Thursday, Senator Bob Casey (D-Pa.) and a host of other cosponsors reintroduced the Better Care Better Jobs Act into the Senate.

The other lawmakers included Congresswoman Debbie Dingell (D-Mich.), energy and commerce ranking member Frank Pallone (D-N.J.), Congresswoman Jan Schakowsky (D-Ill.), Congresswoman Doris Matsui (D-CA.) and 39 cosponsors in the Senate.

The Better Care Better Jobs Act was originally introduced last year, and was meant to inject billions of dollars into the home-based care sector. The legislation would enhance Medicaid funding for home care and the caregiving workforce, as well as help address the 650,000 people on home- and community-based services waiting lists.


Additionally, it would bump up payment rates with the goal of improving recruitment and retention, increasing wages and developing and updating training opportunities.

Currently, the home care workforce earns a median wage of $13 an hour, according data from the Economic Policy Institute. Plus, about 18% of home care workers live below the federal poverty line, according to PHI data.

The reintroduction of the The Better Care Better Jobs Act should come as no surprise to those who have been paying attention.


On Monday, William A. Dombi, president of the National Association for Home Care & Hospice (NAHC), told Home Care 100 conference attendees that they could expect to see the return of the legislation this year. However, he warned that the legislation may not have the easiest road ahead.

“It will come back in 2023, it’s not going to be an easy climb to success for that,” he said.

The reintroduction of the bill has already received praise from industry advocates like Washington, D.C.-based LeadingAge, an association representing more than 5,000 nonprofit aging services providers and organizations.

“This bill would mean better pay and benefits for care professionals, when almost half of home care worker households must currently depend on some form of public assistance,” LeadingAge President and CEO Katie Smith Sloan said in a press statement. “Increasing compensation is a critical component in recruiting and retaining these valuable workers. Equally important is investment in programs to help train and develop direct care workers and encourage career development. We look forward to working with Congress on this necessary legislation to ensure that older adults’ and families’ can access the help they need.”

Legislative wishlist

The Better Care Better Jobs Act isn’t the only thing that’s top of mind for home-based care industry stakeholders. At NAHC, the final rule is a key area of focus, Dombi told Home Health Care News.

“In terms of the top issues on the home health side, we’ll be doing everything we can to avoid seeing the remainder of the permanent adjustments, and then the temporary adjustments that are in the books, not happen for 2024,” he said.

Along with this, NAHC would like to see a broader set of reforms that address the subsidization of payers like Medicare Advantage (MA) and Medicaid.

“There’s a variety of ways that you could get there that may then allow cuts to happen under traditional Medicare payment rate, but not destabilize home care,” Dombi said. “If you were to cut the Medicare payment rates by 10%, but had all the other payers pay equivalent to the Medicare payment rates — that’s actually good on a much more long-term basis.”

More broadly, NAHC will be advocating for improvements in the home health program under Medicare.

This includes a possible move to get palliative care recognized within the home health benefit as an area of skilled care, according to Dombi.

“The concept being that palliative is not just for end of life,” he said. “I hope all health care has some palliative element to it, so we’ve rewritten the Medicare coverage standards to include that, as the word palliative appears nowhere at all at this point. We are looking to do that as a way of somewhat modernizing the benefit, or making it what it should have been in the first place.”

Through legislative and regulatory action, there’s also hope that the needle can be moved on the telehealth front in home-based care.

On the legislative side, there’s a need for Congress to revise the Medicare payment requirements, which doesn’t allow telehealth to be considered in the reimbursement model.

Ultimately, forging ahead on many of these priorities can lead the way to a more modernized version of home health care services.

“We’d love to see a full modernization of home health, so that we can incorporate the Choose Home concept, but the degree to which that’s a priority is going to depend on how much has to go into stabilizing today,” Dombi said.

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