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Home » As $1.9T Stimulus Bill Heads to Senate, Here’s What It Could Mean for In-Home Care

As $1.9T Stimulus Bill Heads to Senate, Here’s What It Could Mean for In-Home Care


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The House of Representatives passed the Biden administration’s $1.9 trillion stimulus bill Saturday, which means the next step for the “American Rescue Plan” is to go through the Senate, where its provisions related to home-based care will likely be tinkered with again.

Because pandemic-related unemployment benefits are set to expire on March 14, lawmakers are trying to move the bill swiftly through the rest of the process to become law.

As of now, the bill includes a variety of legislative proposals that would be relevant to home-based care providers. But it’s still not guaranteed that those proposals will make it into the bill’s final draft.

One of the major pro-provider items that survived the House is a 7.35% rate increase for states to enhance home- and community-based services during the pandemic. More than 20 Democratic Senators wrote a letter to Senate leadership in mid-February vying for the provision to remain in the final stimulus package.

“We are glad that Senate Democratic leadership supports dedicated emergency funding for HCBS and that the [House committee] … has included a 7.35% increase to Federal Medical Assistance Percentages (FMAP) for HCBS in its proposed budget reconciliation legislation for the next COVID-19 relief package,” the letter read. “We urge that the increased FMAP included in the House proposed legislation remains in the final package.”

The increase would be particularly beneficial to home-based care providers in states facing budget issues. In New York, for example, a budget shortfall could lead to a Medicaid rate reduction, which would directly affect home-based care providers in multiple negative ways. But if passed, this 7.35% rate increase could help.

Like those Democratic Senators, the American Association of Retired Persons (AARP) is also in support of the rate increase and other related provisions. CEO Jo Ann Jenkins wrote a letter to House and Senate leadership last week to ensure that home- and community-based care remains a focus in the bill.

“The devastating impacts of COVID-19 on long-term care facility residents further demonstrates the need for greater investments in home- and community-based services,” Jenkins wrote. “AARP supports the investments in this package that will allow more people to get care at home and stay out of nursing homes when they so choose. These policies not only meet consumer preferences and save lives, but they can save taxpayer money. For each person getting nursing home care, Medicaid can fund three people getting home- and community-based services.”

Even beyond the American Rescue Plan, organizations such as the National Association for Home Care & Hospice (NAHC) and AARP are confident that they have enough support on both sides of the aisle to continue working positively with lawmakers throughout — and beyond — the public health emergency. They’re optimistic that will translate into meaningful legislation for the home health sector and home care industry alike. 

“Congress must make funding home- and community-based services a higher priority,” Jenkins added.

Other beneficial elements of the stimulus package include more than $7 billion to improve the distribution and administration of COVID-19 vaccines nationwide and an additional $46 billion for testing and contract tracing.

The bill also includes $1.4 billion for Older Americans Act programs. That money would go to helping home- and community-based services during the pandemic as well — and also provide more nutrition services and social support for seniors.

Despite those positives, some aspects of the bill, as written, could hurt home-based care providers. Examples include minimum wage increases and other workforce-related changes.

It’s unlikely, however, that those lofty provisions will make it unscathed through the Senate bipartisan bargaining. Whether those provisions will be done away with completely, or just watered down, is still in question.

“The point is that with this close majority, the law has to be moderate enough to not lose any votes,” Angelo Spinola, co-chair of the home health and home care industry group at the law firm Littler Mendelson, said during NAHC’s Winter Leadership Summit last week. 

President Biden’s original proposal incorporated a minimum wage hike to $15 per hour, among other employee-friendly provisions that could jeopardize raising the cost of care for seniors.

“This is not the only way that minimum wage can increase in this industry,” Spinola said. “There is a need and a desire to increase minimum wage [for home-based care workers.] Something needs to be done to reduce the turnover that we’re seeing right to make sure that they’ve got a good living wage. But that should be done in a way that’s holistic, where we’re also thinking about what are reimbursement rates for the government programs.”

Spinola believes that some of the workers’ rights elements of the bill could survive, but if they did, they’d be carved down from where they started.

The bill would not require businesses to offer paid leave, but emergency pandemic unemployment assistance would be expanded until Aug. 29. The weekly unemployment benefits would increase from $300 to $400 beginning in March, if passed on time.

Home-based care providers were dealt a blow at the beginning of the COVID-19 crisis when $600 unemployment add-ons led to many workers opting out of their jobs and staying home.

Providers are hopeful that will less of a problem time around, though, as vaccines become more widely available to the workforce and agencies have the ability to provide the necessary personal protective equipment (PPE).

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