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President Biden Announces Framework to Invest $150 Billion in the Direct Care Workforce

President Biden Announces Framework to Invest $150 Billion in the Direct Care Workforce

Today, after months of negotiations with Congress, President Joe Biden unveiled a monumental framework for the Build Back Better Act (BBB), legislation that seeks to "rebuild the backbone of the country — the middle class — so that this time everyone comes along," according to The White House announcement. In total, the BBB calls for $1.75 trillion in spending, down from the initial proposal of $3.5 trillion.

President Biden developed the framework with the input of congressional leaders and members and expressed confidence in Congress being able to pass the legislation.

President Biden's framework includes a historic $150 billion investment in the direct care workforce and the home and community-based services (HCBS) sector. While this funding amount is significantly smaller than the $400 billion that was initially sought, it marks a major step forward in addressing the direct care workforce shortage crisis.

More specifically, the HCBS funding includes the following provisions:

  • 7% increase in Federal Medical Assistance Percentages (FMAP) for Medicaid HCBS through September 2031
  • Maintenance of effort; new federal funds may only be used to supplement — not supplant — current state spending on HCBS
  • Requires coverage of personal care services
  • Support for family caregivers to include respite care
  • Requires for states to update and increase payment rates to support recruitment and retention of direct care workers
  • Requires states to review and, if necessary, increase Medicaid payment rates to ensure sufficient access to care every three years
  • Makes permanent the Medicaid Money Follows the Person demonstration program
  • Makes permanent protections against spousal impoverishment for HCBS beneficiaries

For full legislative language, click here. HCBS-specific provisions begin on page 568.

The Build Back Better Act framework also includes sizable and unprecedented investments in child care, pre-school, equity, immigration, affordable housing, health coverage, rural communities, and climate change, among other areas, all of which will greatly support direct care workers in their jobs and lives.

The White House made the announcement today with the following summary of the direct care provisions of the legislation. Click here to learn more about the details of the framework.

Deliver affordable, high-quality care for older Americans and people with disabilities in their homes, while supporting the workers who provide this care. Right now, there are hundreds of thousands of older Americans and Americans with disabilities on waiting lists for home care services or struggling to afford the care they need, including more than 800,000 who are on state Medicaid waiting lists. A family paying for home care costs out of pocket currently pays around $5,800 per year for just four hours of home care per week. The Build Back Better framework will permanently improve Medicaid coverage for home care services for seniors and people with disabilities, making the most transformative investment in access to home care in 40 years, when these services were first authorized for Medicaid. The framework will improve the quality of caregiving jobs, which will, in turn, help to improve the quality of care provided to beneficiaries.

Stay tuned for more information as the legislative process gets underway and opportunities to contact your members of Congress in support of the Build Back Better Act.

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