HCAOA Analyzing Better Care Better Jobs Act

On June 24, Sens. Bob Casey (D-PA), Ron Wyden (D-OR), and Rep. Debbie Dingell (D-MI) announced new legislation, the Better Care Better Jobs Act (S. 2210/H.R. 4131) which would strengthen home- and community-based services (HCBS) by giving states more money to expand access to their Medicaid home-based care programs and strengthen the home-based care workforce. "We continue to review and analyze various components of this legislation and will share our analysis with our members shortly, stated HCAOA Executive Director, Vicki Hoak. "However we immediately see the positive aspects:​

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Medicaid expansion, streamlining eligibility, promoting the Money Follows the Person, supporting family caregivers, as well as efforts to increase Medicaid reimbursement so that workers receive higher wages." Hoak continued, "we have serious concerns about other provisions including expansion of consumer directed models, unionization efforts and establishing direct care worker registries. These are significant issues for home care providers and HCAOA is committed to representing our member concerns and working with legislators to make certain our voices are heard.”  

This legislation comes as lawmakers continue to debate the role that “caregiving” plays in the nation’s current and future infrastructure. President Biden called for a $400 billion boost to HCBS as part of his American Jobs Plan proposal, but Republican leaders opposed the boost, arguing that “infrastructure” only applies to things like roads, bridges and railways.

After Sens. Casey and Wyden and Rep. Dingell announced the Better Care Better Jobs Act, President Biden announced a new $579 billion infrastructure deal with leaders from both parties that does not include any investments in home-based care. While the situation is still very fluid, it is expected that investments in HCBS will be part of a separate package of legislation that may receive only Democratic votes in the Senate but it is too soon to tell whether the Democrats can keep all their members on board. This will likely play out through the summer.  

Other proposals in the Better Care Better Jobs Act would make: 

• States eligible for a permanent 10 percentage point increase in the federal Medicaid match (FMAP) for delivering HCBS
• Spousal-impoverishment protection in Medicaid permanent and 
• The Money Follows the Person program permanent, to help people transition from nursing homes back to their homes in the community.  

​HCAOA supports investments in the home based-care industry and our workforce. However, there are several areas of concern with the bill. Temporary increases in funding potentially set up instability for home care providers, leaving millions of seniors and people with disabilities without access to this critical care. In addition, while HCAOA supports initiatives that benefit direct care workers and care recipients, such as increased training and access, the association believes strengthening relationships between owners and their workers is the best way to build a strong team to deliver in-home care. 

Read the full language of the bill here: aging.senate.gov/imo/media/doc/Better%20Care%20Better%20Jobs%20Act%20Text%2006-24-21%20For%20Distribution.pdf