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Concerns grow over home health care as Democrats debate funding

Lauren Clason, CQ-Roll Call on

Published in News & Features

Advocates are concerned that a proposed boost to Medicaid and home health care for the elderly and disabled in Democrats’ $3.5 trillion budget bill will be pared back so much that it wouldn’t deliver on its promise to increase jobs and wages.

The topline funding number for home- and community-based services has wavered between $150 billion over 10 years and President Joe Biden’s initial request of $400 billion over eight years. The House bill currently would set the 10-year spending level at $190 billion, lower than what advocates view as sufficient.

But congressional leadership is expected to trim the $3.5 trillion bill to around $2 trillion over a decade in an effort to please fiscally moderate Democrats like Sens. Joe Manchin III of West Virginia and Kyrsten Sinema of Arizona.

The need for home care is only expected to grow, as around 10,000 seniors reach retirement age every day. Advocates point to long-term savings as a reason to fully fund an expansion since home care is traditionally less expensive than institutional care.

“We have seen huge losses of life in congregate settings alone, and so we need to provide some type of outlet or valve to that issue, and we’re going to be seeing even more individuals with disabilities in the future,” said Mia Ives-Rublee, director of the Disability Justice Initiative at the liberal think tank Center for American Progress.

“We’re talking about baby boomers who are retiring and getting older and getting sicker,” she said. “We’re talking about individuals who have long-haul COVID, who have significant disabilities, who are going to likely need that long-term service.”


Lawmakers are aiming to eliminate the 800,000-plus waitlist for home and community care under Medicaid by increasing federal matching rates for improvements to staffing and pay, expanded eligibility and additional services. Right now, states are required to cover some intermittent home health care but are not required to cover things like daily personal care or certain types of therapy.

Advocates estimate that at least $250 billion over a decade is needed to adequately fund a broad expansion and convince states to come on board. Congressional allies like Pennsylvania Democrat Bob Casey, chairman of the Senate Special Aging Committee, and Rep. Debbie Dingell, D-Mich., are working to secure at least that amount in the final package, which lawmakers hope to pass under a simple Senate majority through the rules of budget reconciliation.

In an interview Monday, Dingell said Biden assured her last week during his visit to Capitol Hill that funding was still in the package, but the amount remains unclear. She declined to say whether she thinks $190 billion is sufficient but expressed opposition to further reducing the number.

“This is a priority,” she told CQ Roll Call. “I mean, it is the most popular thing in all of this bill, that people want something to happen.”


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