The Better Care Better Jobs Act, introduced in June 2021, is poised to bring much-needed assistance to seniors, people with disabilities, and those who care for them.
The act is a historic investment in efforts to enable seniors and people with disabilities to remain in their homes and communities while still having access to the quality of care they’d receive in a long-term health care facility. It pushes for better pay and benefits for care workers to facilitate this high quality of in-home or community care.
“For too long, seniors and Americans with disabilities who want the choice of good-quality, long-term care at home and the workers who provide it have gotten short shrift,” said Senate Finance Committee Chairman Ron Wyden, an original Senate cosponsor of the bill. “This bill lays out a transformational investment through Medicaid that will begin to set that right so receiving good-quality care in the comfort and safety of home is a real possibility.”
Introduced by Congresswoman Debbie Dingell (MI-12) and Senator Bob Casey (D-PA) on June 24, 2021, the Better Care Better Jobs act extends the $12.7 billion short-term home and community-based services (HCBS) funding attached to President Joe Biden’s American Rescue Plan.
HCBS works to provide Medicaid beneficiaries access to services within their own home or community rather than institutions or other isolated settings. In addition to seniors, HCBS programs also serve people with intellectual or developmental disabilities, physical disabilities, and/or mental illnesses.
The current HCBS challenges
Several fundamental barriers currently exist with HCBS programs and services.
Access and eligibility
For one, eligibility and benefit standards vary across states, leaving significant inconsistencies and gaps in coverage. Funding restrictions and/or poorly administered fund distribution have forced many states to cap the number of recipients, leaving almost 820,000 Americans on waiting lists for HCBS services.
Rising demand for services
Each day, nearly 10,000 American seniors turn 65, and the majority of them are hoping to age in their own homes, placing additional stress on an already overextended HCBS system. Further, experts estimate that by 2028, America will need to fill 4.5 million additional home care jobs to meet the needs of the aging Baby Boomer population.
Quality of care
In addition, the Better Care Better Jobs Act prioritizes wage and benefit increases for home care workers—a majority of whom are women and people of color. The national average for home care workers is $12 per hour, which is well below the living wage in most states and slightly below the poverty level according to the 2022 Federal Poverty Guidelines (based on U.S. Department of Health and Human Services thresholds). In addition, most of these workers receive few or no benefits. The combination of insufficient compensation and the difficulty of their work means an exceptionally high turnover rate among direct care workers (40 to 60%). To make matters more difficult, most direct care workers cannot join a union, which is a fundamental right of the American people. All of these variables negatively impact the quality of care.
“No one should have to wait to get the care they deserve, and no care worker should have to live below the poverty line to give this care,” said Rep. Dingell in a press release. “This is personal for me—I was so lucky to have my husband John receive care at home. That experience showed me the significant fractures in long-term care, from low wages for workers to thousands on HCBS waitlists to so many people not knowing how to get the care they desperately need. We need a stronger system that supports both care workers and care recipients, and this legislation is a historic step forward to expand HCBS so that seniors and people with disabilities can get the care they need in the setting of their choice, while also ensuring care workers are receiving pay and benefits commensurate with their work.”
Better Care Better Jobs Act proposes a solution
However, in 2021, home care workers came out in force, exercising their right to vote their way to equality and fair pay. The direct care workers were among the key voting populations that gave the Democratic Party control over the White House and Congress. As a result, more than $150 billion has been proposed to rebuild the infrastructure of HCBS and, subsequently, their livelihoods.
The Better Care Better Jobs Act proposes increased funding for HCBS in the form of a permanent 10% increase in the federal Medicaid match for delivering HCBS and an increase in administrative funding for activities associated with improvement efforts.
To be eligible for the increased funding, states must expand access to HCBS and improve care in several ways, as listed in a fact sheet released by the bill’s sponsors:
- Expanding the financial eligibility criteria for HCBS to federal limits
- Requiring coverage for personal care services
- Adopting programs that help people navigate enrollment and eligibility
- Expanding access to behavioral health care
- Improving coordination with housing, transportation, and employment supports, and developing or enhancing programs that allow working people with disabilities to access HCBS
States must also improve working conditions for direct care workers by:
- Addressing HCBS payment rates to resolve the high turnover rates of direct care workers and attract additional workers to the workforce
- Regularly updating these payment rates according to public input
- Passing rate increases through to direct care workers as a way to increase their wages
- Updating and developing training opportunities for direct care workers as well as family caregivers
How they will measure improvements in care and jobs
Additional quality control measures have been implemented to ensure the above strategies are effectively in place for states to continue receiving HCBS funding. More specifically, they must demonstrate that services are more available and that access to these services has increased and shown evidence of competitive wages and benefits for care workers. Medicaid will give additional incentives to states that demonstrate innovative HCBS fund-utilization models.
How the Better Care Better Jobs Acts will impact direct care workers and caregivers
The Better Care Better Jobs Act would bring in desperately needed reinforcement for today’s direct care workers and caregivers struggling to manage the heavy load of responsibility placed on their shoulders. It would also boost the economy and lower the unemployment rate according to a recent analysis by Richard Frank, PhD, and Jonathan Gruber, which also found that the act would create more than 500,000 new direct care jobs and provide respite care and other paid support. This influx of paid caregivers would enable millions of family caregivers to get back to the paid workforce, should they wish to do so.
“The care economy is the foundation of the entire economy,” said Ai-jen Poo, executive director of the National Domestic Workers Alliance. “We have an opportunity to expand access to the critical services millions of Americans depend on to live at home with dignity, and invest in the essential workforce who provide these services. This legislation will strengthen the care infrastructure we all rely on. We urge lawmakers to support this important piece of legislation.”