As Congress heads into recess until September 9, significant legislative and agency activities have taken place that are crucial for the Medicaid home-based care community. Before adjourning, the Senate Appropriations Committee advanced several Fiscal Year (FY) 2025 spending bills, including the Labor, Health and Human Services (HHS), Education, and Related Agencies measure, which has direct implications for home- and community-based services (HCBS) and the direct care workforce.

Senate Appropriations Committee Markup

On August 1, the Senate Appropriations Committee held a markup session for the FY 2025 appropriations bills. The Labor, HHS, Education, and Related Agencies appropriations bill was favorably reported by a 25-3 vote. This bill includes provisions aimed at increasing access to HCBS and addressing the direct care worker shortage, which are critical issues for the home-based care sector. Please find the bill text here, bill summary here, adopted amendments here, and report language here.

Key provisions include:

• HCBS Access: The committee supports expanding HCBS access, including bolstering family caregivers and direct care workers. The committee urges the Centers for Medicare & Medicaid Services (CMS) to strengthen HCBS access, encourage innovative workforce models, and provide guidance on implementing intensive home-based behavioral health services.
• Direct Care Worker Shortage: The committee expressed concern about the shortage of direct care workers, especially as the aging population continues to grow. The Department of Health and Human Services (HHS) is encouraged to study the effects of these shortages on long-term care affordability and accessibility.

Senate HELP Committee Advances Older Americans Reauthorization Act

On July 31, the Senate Health, Education, Labor, and Pensions (HELP) Committee approved the Older Americans Reauthorization Act (S.4776) with a 20-1 vote. This legislation reauthorizes critical programs for older Americans, including the Older Americans Act, for another five years. The bill also extends the RAISE Family Caregivers Act and supports age-friendly communities and flexible nutrition programs.

Medicaid Enrollment Update

CMS released updated Medicaid enrollment data on July 31. As of April 2024, over 81.6 million individuals were enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), reflecting a 13% decrease since March 2023. This drop follows the end of the Medicaid continuous enrollment condition.

Legislation and Reports to Note

• Health Workforce Innovation Act (S.4957): Senators Ron Wyden (D-OR) and Marsha Blackburn (R-TN) introduced this bipartisan bill to address the health professional shortage. The legislation proposes federal grants to support community health centers and rural clinics in developing training models, particularly in underserved areas. Click here for an overview of the legislation.
• Kaiser Family Foundation (KFF) Issue Brief: A new brief from KFF examines the coverage sources for dual eligibles across the nation. It highlights that only 6% of dual eligibles receive both Medicare and Medicaid benefits through a single arrangement, with 55% enrolled in multiple Medicaid delivery systems.

Looking Ahead

Both the House and Senate are in recess until September, with discussions around a likely continuing resolution (CR) expected to dominate the agenda upon their return. Committees may also attempt to advance additional legislation before the election season intensifies.

This period offers a critical window for stakeholders in the home-based care sector to engage with policymakers and advocate for continued support and funding for these essential services. Stay tuned for further updates as Congress resumes its activities next month.