Lawmakers Introduce Bill To Expand Home-Based Care Coverage Under Medicaid

A number of lawmakers – including Sen. Bob Casey (D-Pa.) and Rep. Debbie Dingell (D-Mich.) – introduced a bill Thursday that would expand coverage of home- and community-based services under Medicaid.

The HCBS Access Act was introduced by Casey, as a companion bill to the Better Care Better Jobs Act, which was originally unveiled in 2021 and reintroduced in January.

“The second bill establishes a permanent funding stream to keep the infrastructure strong and to make sure we’re able to continue to pay direct care professionals at a rate that ensures qualified, reliable services in a qualified reliable workforce into the future,” Casey said during a hearing announcing the bill.


The bill would also provide training and support for family or informal caregivers.

The legislation would provide grant funding for states, allowing them to expand their capacity for home-based care services.

So far, the bill has already received strong support from the Partnership for Medicaid Home-Based Care (PMHC).


“PMHC is encouraged by Senator Casey and Representative Dingell’s efforts to continue to bring ongoing focus on the need to treat home-based services as a long-term, viable alternative to facility-based care with sufficient funding to address workforce challenges,” a PMHC spokesperson told Home Health Care News in an email. “Ultimately, we hope to see bipartisan engagement to bring this to fruition to allow us to sustain and improve important long-term supports and services for the people we serve.”

LeadingAge has also been vocal about their support of the legislation, the effort to improve the caregiver workforce and the effort to increase access to home-based care.

“Substantial investments in the direct care workforce, such as those in the HCBS Access Act, are exactly what’s needed to begin to solve the current workforce crisis in aging services,” Katie Smith Sloan, president and CEO of LeadingAge, said in a press statement. “Rather than target one or two areas, this legislation rightly aims to spread workforce resources widely. State and nonprofit-operated apprenticeship and training programs would be eligible for funding, along with initiatives that focus on retention by helping current aging services employees develop their expertise while on the job.”

When it comes to long-term care services, Medicaid pays for nursing home care and other institutional care for individuals that are eligible.

However, Medicaid doesn’t pay for home- and community-based services, except when a waiver has been granted.

“This bill would put both options on equal footing and give families an equal choice between home and community care or institutional care,” Casey and his co-sponsors wrote in a fact sheet.

Other legislative wins in home-based care

In other legislative news, the Kentucky Healthcare Workforce Development Act, which was originally introduced in February, passed in the Kentucky House in a 92-1 vote.

If passed through the Senate, the bill will address workforce challenges by establishing the Kentucky Healthcare Workforce Investment Fund. The fund will create a public-private partnership that centers workforce training and education initiatives.

“The unique aspect here is this allows private entities to contribute and get matched funds by the state,” Evan Reinhardt, executive director of the Kentucky Home Care Association, told HHCN last month. “I think that leverage puts this on a whole new level. That’s one of the biggest opportunities here, particularly for home health.”

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