A $2.3 trillion infrastructure plan proposed by President Biden includes $400 billion to accelerate a shift from institutional care to home and community services through the federal-state Medicaid program. The size of the financial commitment — about 17% of the package — leaves no doubt that Biden intends to put his mark on long-term care.
This could fuel a major expansion of home and community-based services so more people could get care, with a major goal being to raise pay and benefits for workers, nearly all of whom are women, and many from minority and immigrant communities. Hourly wages nationally for caregivers average around $12 an hour. The proposal would also permanently reauthorize a program within Medicaid that helps people move out of nursing homes and back into their communities.
“Nursing homes can be a dangerous place, “ explains Jeffrey Downey, a nursing home abuse attorney located in McLean, Virginia, who prosecutes nursing home abuse and neglect cases in Virginia, DC and Maryland. “This bill could increase people’s life expectancy and quality of life explains Downey, while allowing loved ones to remain at home until they become critically ill. “
According to the American Association of Retired Persons (AARP), 70 percent of people turning 65 today can expect to use some form of long-term care during their lives. Medicaid remains a safety net program and that means middle-class people can face arduous challenges to qualify even if they have staggering expenses for long-term care. Because Biden is funneling his funding boost through Medicaid, that effectively leaves out the middle class.
Medicaid provides coverage to over 70 million Americans – over 20 percent of the population, a number that has risen during the pandemic.
Not surprisingly, Republicans have also questioned whether long-term care has any place in an infrastructure bill. Senate Minority Leader Mitch McConnell called the White House plan a “liberal wish list” mislabeled as infrastructure. In a recent Associated press article, policy consultant Brian Blase, a former Trump White House health care adviser, said a warning flag for Republicans is that Biden’s plan calls for upholding the right of care workers to unionize.
“It seems like it’s a boondoggle to create more union workers and through the unions funnel money back to the Democrats” via campaign contributions, said Blase.
Union officials are not taking the issue lightly. Leslie Frane, Managing Executive Vice President of the Service Employees International Union, which represents many health care workers, told the Associated Press that “It’s just fundamentally unacceptable that federal dollars should go to pay for poverty-level jobs, and we have an opportunity to change that.”
“It is bipartisan to support people who would be eligible for Medicaid staying at home rather than going into institutions,” said Blase. Blase added that loosening eligibility rules will lead to “runaway expenses,” according to the Associated Press.
Currently, Medicaid spends about $200 billion a year on all long-term care needs, according to the Kaiser Family Foundation. Reflecting a growing sentiment that older adults should be able to remain in their homes, more than half the money goes to home and community-based care. The Biden bill would average out to an increase of $40 billion a year over 10 years.
About 4 million people receive home and community-based services, which are less expensive than nursing home care. But an estimated 800,000 are on waiting lists for such services. More than 1 million people live in nursing homes. This is a desperately needed program that should be expanded, explains Downey.
Congressional officials said the approach that is taking shape calls for increasing the federal contribution to states for home and community services while setting some basic national standards. Such standards could include the type and scope of services that states cover as well as a mechanism for raising pay for workers. Congress is also looking at ideas such as creating state registries of qualified caregivers, which could be useful to middle-class people not eligible for Medicaid.
Locally, legislators are holding back comment on the overall infrastructure plan until more details are revealed regarding the revamping of Medicaid. As it stands, the requirements for eligibility are fluid but mostly dependent on income level.
In Washington DC, the requirements vary (See DC Link)
For Maryland and Virginia, the requirements vary as well. In Virginia especially, a line is drawn between medical care and what is called “custodial care,” which includes care in assist for bathing, eating, toileting, and ambulation.
Here is a snapshot as nationally for long-term care costs: $8,000 for a semi-private room;
AND $1600 for adult health care;
AND $4,500 for home health care;
You can find more information at this link about long-term care. www.genworth.com
If you have a loved one in a nursing home or assisted living facility who has been injured, contact the law office of Jeffrey J. Downey, P.C., for a free consultation.
Law Office of Jeffrey J. Downey, PC