How the House spending bill would pay for care for aging Americans

Articles in this guide describe key features of legislation passed by the House to advance President Biden’s Build Back Better agenda and overhaul social and climate policy in the United States. The bill now moves to the Senate.

The House bill targets in-home care for seniors and the disabled, with the goal of also raising wages for those who care for them. The coronavirus has fueled a nationwide conversation about how the country cares for older adults and is accelerating efforts to give people more options of places to live outside of institutional facilities like nursing homes.

  • The bottom line: The legislation infuses roughly $150 billion to in-home and community-based services under Medicaid, which includes services such as assistance with eating and bathing, as well as physical therapy and nursing care.
  • What critics say: Roughly 79 percent of Americans support boosting dollars to Medicaid to increase worker wages and expand in-home care, according to a recent poll by the Kaiser Family Foundation. That includes 95 percent of Democrats, 76 percent of Independents and 67 percent of Republicans. But the biggest issue is the plan’s cost, which has been significantly scaled back.
  • Senate prognosis: High. The chamber is likely to keep the infusion in federal dollars to in-home care, which has been championed by Sen. Robert P. Casey Jr. (D-Pa.).

In-home care historically has long waitlists and is too expensive for many Americans to pay for out of their pockets. Democrats are aiming to bolster payments to Medicaid, the federal-state health program for low-income and disabled Americans, in an effort to increase the availability of in-home care.

The policy comes after the coronavirus tore through nursing homes, killing over 139,000 residents and exposing the country’s fragmented and antiquated way of paying for elder care. The White House estimates the bill includes roughly $150 billion to boost home and community-based services under Medicaid. Infusing more dollars into the program is a key priority for Biden, who this spring proposed a much larger investment of $400 billion.

The details: The social spending bill would permanently increase by 6 percent the funding the federal government gives each state for in-home and community-based services, as long as the state creates a plan for strengthening and expanding services. The money would largely flow through the Medicaid program, although some would also be given to states to create their own plans to bolster in-home care.

The goal would be to help seniors stay in their homes, for example, by reducing the length of waitlists to get these services and increasing wages for chronically underpaid staff. “The idea is to help states build up their infrastructures to be able to serve more people and be able to support the direct care workforce,” said MaryBeth Musumeci, an associate director with the Kaiser Family Foundation.

The economic package also boosts federal payments to states by 80 percent for the administrative costs of improving in-home and community-based services. The legislation permanently extends several programs, such as one aimed at helping states spend more money on in home-care, as opposed to institutional care, and another that ensures a spouse doesn’t have to drain their finances so that their partner can qualify for in-home services under Medicaid.

Development: The Democrats’ coronavirus relief bill that passed in March raised federal funding for in-home care for the first time since the Affordable Care Act passed 11 years ago, but the hike only lasts for a year. Proponents of the policy, such as consumer groups and the Service Employees International Union, a labor giant, have been pushing hard for Congress to do more.

Biden’s Build Back Better spending bill

The latest: House Democrats passed a more than $2 trillion bill to overhaul the country’s health care, climate, education and tax laws.

What’s in it? Here’s a complete guide to what’s in the spending bill and all the ways it would affect America.

Breaking it down: The bill re-envisions the role of government in Americans’ daily lives. Here are details on each of the major parts of the plan: healthcare, taxes, child tax credit, paid family leave, early childhood education, climate change, affordable housing, eldercare, infrastructure and immigration.