A proposed federal bill aims to stabilize home- and community-based services, potentially including those provided in assisted living communities, by dedicating Medicaid funds to states to support their delivery networks, direct care workforces and older adults.
US Sen. Bob Casey (D-PA), chairman of the Senate Special Committee on Aging, said Tuesday that he had introduced the Home and Community-Based Services Relief Act with 17 Democratic colleagues. Under the proposed legislation, states would receive a 10-point increase in the federal match, or FMAP (federal medical assistance percentage), for Medicaid for two fiscal years, to enhance HCBS long-term services and supports, including those provided by assisted living providers.
Funds could be used to increase direct care worker pay and provide benefits, including paid family or sick leave and transportation expenses. Additional funds could be used to support family caregivers, pay for recruiting and training additional direct care workers, and pay for technology to facilitate services. Funding also could help decrease or eliminate HCBS waiting lists.
“Unfortunately, because of our nation’s caregiving crisis, home and community-based care has become increasingly difficult to access,” Casey said in a statement. “By stabilizing and investing in the caregiving workforce, we can better provide seniors and people with disabilities with a real and significant choice to receive care in the setting of their choosing.”
Casey pointed to a 2022 report from ANCOR on the direct care workforce crisis that said that more than 70% of direct service providers had reported being unable to fill LTSS worker vacancies, which reduces HCBS services offered. In that report, 83% of providers said they had turned away new referrals, and 63% said they had discontinued programs and services due to staffing shortages. And 90% said they had struggled to meet quality standards due to the lack of staffing.
Extra HCBS funding during the COVID-19 pandemic helped states and providers retain workers and provide services to more people through worker bonuses, hazard pay and expansion of HCBS eligibility criteria. With that funding ending, Casey said, more than two-thirds of providers are concerned that the high turnover and vacancy rates will worsen.
Earlier this year, Casey introduced the HCBS Access Act to increase the nation’s supply of direct care workers. The bill is a companion to the Better Care Better Jobs Act that Casey previously introduced, which would encourage states to recognize and promote the benefits of assisted living as part of the continuum of care and include those settings in state HCBS plans.
Earlier this month, the Department of Health and Human Services Agency for Healthcare Research and Quality sought input from HCBS providers in assisted living communities and other settings as it develops a technical brief providing an evidence map that summarizes HCBS service categories, effectiveness of interventions for specific conditions and gaps. HHS said that the work will help inform policy development by the agency’s Administration for Community Living and Centers for Medicare & Medicaid Services.
