Where is Long-Term Care Reform Going Now?

Last week, President Biden agreed to eliminate his proposed $ 400 billion increase in the federal share of Medicaid home long-term care services. He made the concession to reach an agreement with a bipartisan group of 21 senators on a much broader physical infrastructure bill. But the failures in the current system of support and services for seniors and youth with disabilities remain serious after the pandemic. What will happen now with long-term care reform?

A shortened version of Biden’s $ 400 Billion Increase in Medicaid Home and Community Services (HCBS) may still be in the cards. Biden and many Congressional Democrats continue to insist that they will include some form of the plan in a large domestic spending bill that Congress is likely to consider in the fall.

This is the measure Democrats hope to pass in a party line vote using arcane Senate rules known as budget reconciliation. While some key Republicans privately acknowledge the need for more HCBS funding, it is unlikely that any will vote in favor. Especially since the Biden and Hill Democrats plan to partially pay it and other provisions by increasing taxes on corporations, a step that Republicans in Congress flatly reject.

Whats Next?

Still, that bill, which will also likely include some form of paid family leave, could win the support of 50 Senate Democrats, including some of the party’s more conservative members, like West Virginia’s Joe Manchin.

But how could it be seen?

To get an idea, take a look at legislation introduced late last week by Senate Committee on Aging Chairman Bob Casey (D-PA), called the Better Care Better Jobs Act. Importantly, 40 Senate Democrats, including Finance Committee Chair Ron Wyden (D-OR) and Democratic Leader Chuck Schumer (D-NY), already support the bill. A similar measure was introduced by Representative Debbie Dingell (D-MI) in the House.

The bill would permanently increase the federal contribution to Medicaid HCBS by 10 percentage points and boost administrative funding to help states expand their HCBS programs.

States could get the most federal match by taking steps like making more people eligible for Medicaid HCBS, requiring coverage for personal care services; expand supports for family caregivers; add information services; better coordinate Medicaid HCBS with housing, transportation, and employment programs; or increase wages and benefits for home care workers.

Federal money would be used to expand services, rather than simply replace state dollars.

How ambitious?

The bill is somewhat less ambitious than an earlier draft that Casey and Dingell distributed this spring. That would have required states to make home care available to Medicaid recipients, just as they must today for nursing home care. But policy experts questioned whether states could provide such care without first creating a broader set of services necessary for a home-based program to function properly.

While the Casey-Dingell bill does not mandate HCBS benefits, it is an effort to build that infrastructure.

There’s a good chance that Democratic leaders will try to add this measure to the broader family-centered reconciliation bill. It’s unclear if even this shortened version is too ambitious for conservative Democrats like Manchin. However, as I have pointed out in the past, West Virginia has one of the highest percentages of low-income seniors in the nation. And about a third of its residents over 65 have Medicaid. Then Manchin should be interested.

Democrats have a very long list of priorities that they would like to address in that reconciliation bill, which could well be the last big law they can pass before the 2022 election. It includes the expansion of public health care, the education and a wide range of safety net programs. The competition for dollars will be intense.

Long-term care public insurance

To win the support of conservative Democrats, party leaders may need to keep the total size of that reconciliation bill at around $ 2 trillion. And that will require them to reduce the expansion of Medicaid HCBS. My best bet: maybe a $ 200 billion increase in the federal share in 10 years.

While most of the focus will be on expanding Medicaid HCBS and family leave, Rep. Tom Suozzi (D-NY) is about to introduce a bill to create a public long-care insurance program. catastrophic term. It is likely to be similar to a 2018 measure proposed by the chairman of the House Energy and Commerce Committee, Frank Pallone (D-NJ) and a 2016 Long-Term Care Financing Collaborative Proposal.

That move will be a much heavier boost than Medicaid expansion. It does not have the support of the White House or the leadership of Congress. It is likely to be funded by its own broad-based tax increase, and Biden says he would oppose any tax increase on those who earn $ 400,000 or less.

Still, Suozzi’s bill could fuel debate in Congress about how to provide more funding for long-term supports and services for the roughly 8 million Americans who need assistance but are not poor enough to qualify for Medicaid.

We are a long way from this year’s major long-term care reform. But don’t rule it out just yet.

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