On Monday, Senate Republicans unveiled a proposal with even deeper cuts than those previously passed by the House, which have drawn strong criticism from the home-based care community. 

The new amendment, published by the Senate Finance Committee, adds a work requirement to Medicaid for adults with older children and further restricts the use of provider taxes beyond what the House bill proposed.

While the proposal does not include language specific to home- and community-based services, it would add to industry struggles, according to Dr. Steven Landers, CEO of The National Alliance for Care at Home (the Alliance).

“We’re seeing continued pressure within this legislation on the Medicaid program,” Landers said on Polsinelli law firm’s Home Care Industry Update webinar on Tuesday. “[There is] no line item related to home- and community-based services and Medicaid. A lot of this relates to the expansion population. However, we know when states get this type of pressure, they will be in a position of having to either cut back on rates, cut back on benefits, cut back on innovation, or waiver programming across the board. So we think there’s a lot at risk.”

Specifically, the Senate plan would gradually lower provider taxes, currently set at 6%, to 3.5% by 2031, according to PBS. The new plan would also impose work requirements for parents of children older than 14, instead of only on childless adults. 

Scalebacks to Medicaid could also impact the home-based care community in less direct ways. Approximately 40% of personal care workers, including home health aides, rely on Medicaid, Landers said, and updates to the expansion population could reduce access to care for those workers.

The updated draft also does not include policies advocated for by the Home Care Association of America, which include targeted tax credits for families seeking home care. 

“The Senate Finance Committee has provided their draft, and unfortunately, neither version includes any of the tax policies that we were promoting and advocating for,” Lee said. “It’s a long game when it comes to public policy. Just because we didn’t get the quote-unquote ‘win’ this time for budget reconciliation doesn’t mean that we won’t have that opportunity in the future.”

The tax policies that HCAOA advocated for are now unlikely to materialize, according to Lee.

While recent legislation falls short of what the home-based care industry advocated for, some positive elements were included in the House bill, Lee said, including an expanded standard deduction for seniors and increased individual care.

While the new proposal goes even further than the highly contested House budget bill, Landers predicts it is likely to pass.

“I still think the betting odds would be that this type of package does get through Congress,” Landers said. “This is their opportunity to get the President’s agenda launched in terms of the recent campaign and election victories, and they only have so many bites at the apple. So there is a political imperative there.”