The Better Care Better Jobs Act, which was originally introduced by Senator Bob Casey (D-PA) and Congresswoman Debbie Dingell (D-MI) in 2022, is designed to provide billions of dollars into the home health care sector with the expansion of access to Medicaid home- and community-based services (HCBS). It’s also designed to strengthen and incentivize workforce growth that benefits direct-care workers with increased wages and updated training opportunities.
The bill stalled in 2022, but gained new life with its reintroduction earlier this year and its many co-sponsors in the Senate. The home health care industry has praised the bill, including William A. Dombi, president of the National Association for Home Care & Hospice (NAHC).
Why The Better Care Better Jobs Act Is Important
More Access to Care
There are more than 3.5 million older adults and persons with disabilities who receive Medicaid HCBS, with eligibility requirements and benefit standards varying from state to state. This leads to coverage gaps and significant benefit variations. In addition, some states cap the number of individuals eligible for services, which leaves almost 820,000 Americans on waiting lists to receive care, according to Home Care. The Act would help address this gap with the following measures:
- Facilitate statewide planning for HCBS infrastructure upgrades
- Increase HCBS Medicaid funding by providing states with a permanent increase in federal Medicaid match if they expand HCBS access and strengthen the HCBS workforce
- Encourage innovative models that benefit direct-care workers and care recipients, such as building HCBS workforce programs that register care workers; help connect them to seniors and people with disabilities seeking care; facilitate coordination between the state and workers; support safety and quality; and other measures
- Support quality and accountability by funding programs through the Centers for Medicare and Medicaid Services (CMS) and providing oversight and technical assistance to program coordinators
- Permanently authorize protection from impoverishment for people whose spouses received Medicaid HCBS, as well as the “Money Follows the Person” program to help people transition from institutions to homes or communities
Taking Care of the Care Workers
The bill’s goal is also to address the home care workforce. Workforce recruitment and retention are major issues for HCBS providers, with many claiming that Medicaid reimbursement rates prevent them from competing with other professions. To address these issues, the Better Care Better Jobs Act would:
- Address HCBS payment rates to encourage direct-care worker recruitment and retention
- Update payment rates on a regular basis using public input
- Pass rate increases through to direct-care workers to increase wages: Home care services earn a median wage of $13 per hour and are, for the most part, women and people of color; about 18% home care workers live below the federal poverty line, according to PHI data
- Update and expand training opportunities for this workforce and family caregivers
The Better Care Better Jobs Act is supported by more than 800 organizations and experts representing care workers, people with disabilities, older adults, and more.
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