As States Negotiate Budgets, Biden’s Executive Order Puts Home-Based Care At The Forefront

In tandem with an executive order, the White House announced a bevy of directives for government agencies on Tuesday, many of which were centered around bettering home-based care.

Perhaps most notable is the timing, however. As states work through their budgets and potential Medicaid spending, the Biden administration has put home care at the forefront of their minds.

“In a lot of states, they’re actively finalizing state budgets,” Debra Oberman, the SVP of government relations at Help at Home, told Home Health Care News. “What this does is lift up these issues at a time where states are actively negotiating and looking at Medicaid funding and budgets.”


Particularly with Medicaid budgets in better position than they were prior to the pandemic, having the White House behind these initiatives could be what bolsters home-based care accessibility in some states.

The president’s directives could affect a few areas under the broader “home-based care” umbrella, including home care for veterans, caregiver job quality and family caregivers.

In general, advocates were happy with the executive order, seeing it as yet another signal that there is bipartisan support for home-based care initiatives.


“NAHC applauds President Biden’s vigorous efforts to support home- and community-based care through a series of executive orders affecting Medicaid, VA health benefits and more,” NAHC President William A. Dombi said in a statement shared with HHCN. “We face significant and growing challenges to meet the needs of our country’s increasing aged population that warrants improved access to home care. We commit to work with the administration as it carries out the president’s plan to secure high-quality and accessible home care through dedicated caregivers.”

Home Care Association of America (HCAOA) CEO Vicki Hoak said she appreciated the continued focus on home-based care from the White House, but that her organization was still reviewing specifics of the directives and how — or if — they may benefit the industry.

“HCAOA is appreciative of the Biden Administration’s continued focus on home-based care, the agencies and caregivers who provide it, and the seniors and people with disabilities who rely on it,” Hoak said. “We look forward to reviewing the executive order to make sure its 50-plus directives best support the growth of our industry.”

Improving home-based care

The administration intends to “improve home-based care access” for veterans by directing the Department of Veterans Affairs (VA) to do so, namely through giving the agency more decision-making power over “who delivers that care and when.” Part of that will include potentially providing veterans with a budget to hire personal care assistants on their own, including family members.

Additionally, the VA will consider piloting a new self-directed care program in “no fewer than” five new sites, according to the White House. It will also look to expand home-based primary care availability for an additional 5,600 veterans.

The veteran initiative seems to be a direct response to the fact that there is a shortage of caregivers in the U.S.

In order to improve that, the executive order will also direct the Department of Health and Human Services (HHS) to consider “issuing several regulations and guidance documents to improve the quality of home care jobs.” Those guidelines will include leveraging Medicaid funding to ensure there are “enough home care workers to provide care to seniors.”

The White House statement mentioned elsewhere that more than three-quarters of home- and community-based services providers are unable to accept new clients due to the staffing shortage.

While the White House statement emphasized the need for more home-based care workers, it also got at what could be considered one of the root problems of the issue, which is the quality of those jobs.

The administration mentioned its commitment to improving the quality of long-term care jobs, whether in the home or in brick-and-mortar facilities.

“What stood out to us the most is that there’s a theme of support for the caregiver,” Oberman said. “It’s not just about funding. There’s a consideration for the training, development and support of paid and unpaid caregivers. It’s about professionalizing these roles. … And I think that was a theme.”

The Biden administration also allocated $150 billion for home- and community-based services – to be dispersed over the next 10 years – as part of its 2024 proposed budget.

In addition to leveraging Medicaid dollars to support current and future agency-employed caregivers, the White House is taking aim at family caregivers.

The emerging availability self-directed care offers family caregivers the ability to be paid for their labor. In addition to that, the White House wants to provide support for family caregivers during the hospital discharge process. It also wants to test a new dementia support model that would include respite care for family caregivers.

Finally, as part of the over 50 directives, the White House wants to advance direct care workers’ rights. To do so, it wants to require the U.S. Department of Labor (DOL) to publish a sample employment agreement so direct caregivers understand their rights.

“Care workers should be supported, valued, and fairly compensated, and care workers should have the free and fair choice to join a union,” the White House added. “In particular, domestic workers providing care for our loved ones are often underpaid and subject to discrimination and abuse.”

While home-based care providers in general were happy to see home-based care highlighted by the White House again, advocacy organizations like LeadingAge took umbrage with the scope of the directives.

“The focus on home- and community-based services is too limited and must extend beyond care in the home to address the breadth of the aging care continuum,” LeadingAge President and CEO Katie Smith Sloan said in a statement shared with HHCN. “It doesn’t provide support for other care settings like adult day programs, assisted living, hospice and more, on which millions of older adults and families rely.”

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