As part of its infrastructure proposal to Congress, the Biden administration has proposed to spend an extra $400 billion over the next ten years on home care benefits for the disabled and elderly through the Medicaid program. This is an extraordinary amount of money, relative to the $2 trillion infrastructure package, to the $235 billion spent nationally each year on long-term services and supports (LTSS), and to the $134 billion paid annually by Medicaid for LTSS. What is the intended purpose of these funds? Who would benefit? Who would be harmed? Are there any hidden agendas? There have been many discussions over the years to create a federal long-term services and supports social insurance program like Medicare. Is this the beginning of such a plan?
While the presidential fact sheet is quite sparse on details, it states that through Medicaid, the proposal would provide extra federal resources to pay for additional home and community-based services (HCBS) such as personal care and home health. Medicaid, a combined federal and state-designed and funded health care and LTSS program, now covers individuals in state-defined health and functional and financial need. It also covers stays in nursing homes as an entitlement, regardless of budgets. While advocates claim that state budgets limit Medicaid spending on home care, the reality is that the growing majority of Medicaid spending on LTSS is already devoted to home care. The administration’s fact sheet also states that the new funds would raise the wages and benefits of workers in this specific sector through state mechanisms providing an enhanced ability to organize and collectively bargain. Changes in Medicaid eligibility rules are not proposed.
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