October 25, 2023  – The wave of strengthening home- and community-based services (HCBS) has been growing over recent years, with numerous states expanding the reach and quality of these programs. Now, a fresh push from over a dozen members of Congress aims to cover more services and increase rates.

“A vast majority of seniors and people with disabilities would prefer to receive care at home or in their communities,” U.S. Sen. Bob Casey (D-Penn.) said in a statement. “Unfortunately, because of our nation’s caregiving crisis, home and community-based care has become increasingly difficult to access. By stabilizing and investing in the caregiving workforce, we can better provide seniors and people with disabilities with a real and significant choice to receive care in the setting of their choosing.”

Casey, steering the U.S. Senate Special Committee on Aging, unveiled the Home and Community-Based Services Relief Act this week. Supported by 17 fellow Congress members, the bill has been crafted to direct Medicaid funds toward states over two years, aiming for a more stable HCBS landscape.

But the bill’s aspirations don’t stop there. It also targets the enhancement of states’ ability to attract and keep HCBS care professionals.

While every state, including Washington D.C., currently offers HCBS to qualified seniors aged 65 and above, the specifics of these benefits and who is eligible differ broadly. A considerable portion of senior citizens on Medicaid opts for long-term services and supports (LTSS) at home. However, dwindling staff and limited funds have presented hurdles for HCBS providers.

If this new piece of legislation passes, states will see a 10% surge in the federal match for Medicaid over two fiscal years to bolster HCBS services and programs. These funds could potentially boost care worker salaries, cover transportation costs for those receiving HCBS care, and fund family or sick leave.

The legislation is not out of left field. In fact, it aligns with the present administration’s vocal support for HCBS. 

One issue looms heavily over the HCBS industry. A recent Kaiser Family Foundation study disclosed that every state grapples with HCBS workforce shortages. Every state faces these shortages in more than one workforce domain. 

“Such shortages may reflect ongoing effects from the pandemic, but also low levels of compensation coupled with increasing requirements of providers,” the survey summary stated. “In the summer of 2021, HCBS providers in focus groups reported that their jobs had high physical demands and mental demands that were often ‘overwhelming.’ The groups described their wages as low, particularly given the demands of their jobs; and how staffing shortages made their jobs harder because they may not know if they would be able to leave work at the end of their shift.”

To address these challenges, states have been amplifying provider payment rates, increasing worker pay, and refined training. However, states need more sustainable solutions. This new legislation, combined with other innovative measures like social media campaigns and improved outreach, might be the key to flipping the script.