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The HCBS Relief Act: A Timely Response to America’s Caregiving Crisis

November 8, 2023

The Home- and Community-Based Services (HCBS) landscape in the United States is at a critical juncture. A recent report highlighted that all states reported shortages of HCBS workers, most frequently among direct support professionals, personal care attendants, nursing staff, and home health aides. Additionally, most (43) states reported permanent closures of HCBS providers within the last year. The crisis is real, and it harms workers, individuals receiving services, and family members alike.

In response to this pressing issue, U.S. Senator Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, has introduced the Home and Community-Based Services (HCBS) Relief Act. This bill would give states two years of dedicated Medicaid funds to stabilize their HCBS service delivery networks, recruit and retain direct care workers, and meet the long-term service and support needs of people eligible for Medicaid home and community-based services. In short, the Act would bring significant new federal investments to help states get people the services they need at home and in the community.

The HCBS Relief Act: What It Entails

If passed, for two years, the federal government would increase by 10% the Federal Medical Assistance Percentage (FMAP) for state Medicaid programs. This would mean hundreds of millions of additional dollars that states would have to use to improve access to HCBS. States have freedom in exactly how they would bolster their HCBS systems, but options include addressing key needs of the direct care workforce by:

Additional funds could also be used to support family caregivers, pay for the recruitment and training of additional direct care workers, and pay for technology to facilitate services.

The Importance of Home and Community-Based Services

More than 90% of those eligible for Medicaid long-term services and supports prefer to receive these services in their homes. However, the current system struggles to meet this demand due to staffing shortages and other challenges. The HCBS Relief Act not only seeks to provide financial support to the system but also places a strong emphasis on bolstering the workforce. It recognizes the vital role of direct care workers and aims to enhance their job quality, stability, and overall support, ensuring that they are equipped and motivated to deliver the best care possible.

Building on Previous Efforts

Senator Casey has a long-standing record of advocating for increased federal support for state-funded home and community-based long-term care services. Earlier this year, he reintroduced the Better Care Better Jobs Act, which also aimed to enhance Medicaid funding for home care services. The HCBS Relief Act builds on these efforts, offering a more immediate response to the current crisis.

Economic Benefits and Sustainability

In a recent hearing, Senator Casey emphasized the economic benefits of investing in Medicaid HCBS. Direct care workers, who earn a median wage of roughly $14 per hour, play a critical role in the lives of millions of Americans. Investing in this workforce not only improves the quality of care but also has broader economic implications. The HCBS Relief Act serves as a bridge toward longer-term expansion and sustainability, particularly as the temporary federal investment from the American Rescue Plan Act (ARPA) comes to an end.

The Road Ahead

PHI strongly supports the HCBS Relief Act, joining a growing chorus of advocates and organizations pushing for the bill’s passage, recognizing its potential to improve the caregiving landscape in America. While the HCBS Relief Act is a significant step in the right direction, it is not the end of the journey. Longer-term investment is essential for the sustainability and expansion of HCBS.

The HCBS Relief Act comes at a time when the need for robust home and community-based services is more pressing than ever. By providing dedicated funding to stabilize HCBS programs and support direct care workers, the legislation offers a pragmatic solution to a complex problem. It is an important step forward in addressing America’s caregiving crisis and ensuring that individuals can receive the care they need in the setting of their choice.

For more information on the HCBS Relief Act, view Senator Casey’s official release.

Contributing Authors

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