Biden $400 Billion Care Plan Would Have A Caveat: States Decide In

WASHINGTON – President Joe Biden’s ambitious $ 400 billion plan to improve home care for the elderly and raise wages for millions of workers may be constrained by state opt-out due to previous proposals by Congress.

The leading bill under discussion would channel funds through the U.S. government’s Medicaid health insurance program and tie the money to higher reimbursement rates and homeworker training, according to Congressional Assistants familiar with the matter who refused to be identified because the deliberations are on Private.

Funding through Medicaid, which already processes payments for most of the personal care services for the elderly and the disabled, is seen as the fastest, most direct way to get the money out.

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But states that administer Medicaid would be responsible for passing higher wages on to workers and have the option of taking the federal money or not, according to the population. This would be akin to Medicaid’s expansion under the Affordable Care Act, which a dozen states failed to enact. The proposal has not yet been finalized and details may change in the course of discussions.

Going through Medicaid would curtail Biden’s plan for home care and increase inequalities along state lines. Some of the worst-paid domestic workers – the vast majority of whom are women, minority groups, and immigrants – are in southern and Republican states that have not adopted the Medicaid expansion under Obamacare.

The mammoth task of home care overhaul in the United States illustrates the many challenges the Biden administration faces in implementing and funding its $ 4 trillion economic proposals. As the population ages, home care workers have become one of the fastest growing segments of the job market, and yet they are currently so poorly paid that one in six lives in poverty, according to the Paraprofessional Healthcare Institute, New York-based nonprofit, which for caregivers.

“It’s significant, it’s historical, but it’s only the first step,” said Robert Espinoza, vice president of politics at PHI, of Biden’s plan. “It could be successful, but in a measured way. Success can be unequal. “

The plan is now in the hands of Congress, where at least four committees are preparing a bill with input from stakeholders on aging, people with disabilities, and working groups.

The main proposal is headed by Sens. Bob Casey of Pennsylvania, Maggie Hassan of New Hampshire, Sherrod Brown of Ohio, and Rep. Debbie Dingell of Michigan, all Democrats. To encourage state buy-in, their drafts called on the federal government to pay most or all of the costs for the first few years, the aides said.

Medicaid is the largest payer for long-term support services like home care. The domestic and community-based service program is optional for states, which has resulted in a patchwork system with different eligibility, plans, and funding in each state.

The president supports the investment of the funds in HCBS, said an administrative official who refused to be identified because the proposal is not final. With Congress still working on the legislation, the White House has not yet weighed down the mechanics and many options are still on the table, the official said.

The Biden administration aims to improve the quality of care for the 14 million elderly Americans who will need the services four decades from now – twice as much as today. The need for home care workers, which exploded from less than 1 million 10 years ago to nearly 2.4 million in 2019, is only set to increase.

“It is incredibly important that the jobs created in home health work are good jobs,” said Heather Boushey, a member of the White House Economic Advisory Council, which focuses on caring for children and the elderly.

Most of home care is paid for through Medicaid through a “fee-for-service” platform. Many workers are contractors rather than full-time workers, which means that they are deprived of federal wage protection. The education system is also fragmented and career advancement is difficult. This contributes to high fluctuation and lower job quality.

The creation of well-paid union jobs is one of Biden’s selling points for its economic overhaul. Stakeholders are pushing for action beyond Casey’s bill to achieve this goal, although they face opposition and may not pass. The general idea of ​​the Democrats to come up with proposals is to leave it to the states to decide how the money will go to the workers.

The National Domestic Workers Alliance aims to create health care “hubs” where consumers can find care and workers can be trained. This would minimize the need for private agencies currently doing this. The new companies could also take over payroll and negotiate higher wages, which the Service Employees International Union is demanding, according to the population.

“There are public health benefits, caregiver safety, and economic stimulus and overall economic growth,” said Haeyoung Yoon, senior policy director at NDWA. “We want everyone to earn a family-friendly wage and have a real shot at this economic security.”

The SEIU, which represents around 740,000 domestic workers and is the leading union in the talks, has proposed going one step further and let the new units take on the role of employers, according to two people familiar with the thinking.

SEIU President Mary Kay Henry, in a statement sent by email, urged Congress “to swiftly adopt the American employment plan and this bold investment in good union and living jobs”. The union did not respond to questions about the structure of the legislation.

Lydia Nakiberu will conduct a litmus test for Biden’s home care plan.

The 42-year-old mother of three works 12-hour shifts several days a week bathing, feeding and administering insulin to an elderly man with dementia in Pepperell, Massachusetts. makes it difficult for her to pay gas, electricity, and mortgage payments on time.

“We are undervalued in our work, we are underpaid,” said Nakiberu, an NDWA member. “If they increase our wages, it will definitely improve our lives.”

A sensitive point in the political talks has been the allocation of resources to balance the needs of the workforce and the people who care for them.

“That is exactly the calculation right now – how big can we be to create entitlement to these services while ensuring that the workforce receives a family-supporting wage,” said Nicole Jorwic, senior director of public policy at The Arc of the United States that work for people with intellectual and developmental disorders. “It has to be a ‘both, and’ that Congress is grappling with.”

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