Policy Corner: November 3, 2023
Categories: Policy Corner Archives
Senators Announce Legislation to Bolster Homecare Workforce
Last week, Senator Bob Casey (D-Pa.), Chairman of the U.S. Senate Special Committee on Aging, announced the introduction of S. 3118, the Home and Community-Based Services (HCBS) Relief Act, along with 20 co-sponsors, to provide support to state programs that fund home and community-based long-term care services. Currently, staffing shortages at direct care providers have led to a reduction in HCBS availability. The HCBS Relief Act would provide dedicated Medicaid funds to states for two years to stabilize their HCBS service delivery networks, recruit and retain HCBS direct care workers, and meet the long-term service and support needs of people eligible for Medicaid home and community-based services.
Under the HCBS Relief Act, States would receive a 10-point increase in the federal match (FMAP) for Medicaid for two fiscal years to enhance HCBS. Funds could be used to increase direct care worker pay, provide benefits such as paid family leave or sick leave, and pay for transportation expenses to and from the homes of those being served. The additional funds also can be used to support family caregivers, pay for recruitment and training of additional direct care workers, and pay for technology to facilitate services.
In January 2023, Chairman Casey introduced the Better Care Better Jobs Act, with 41 co-sponsors, to enhance Medicaid funding for home care services for older adults, people with disabilities, and injured workers to help many of the over 650,000 people on waiting lists nationally finally receive care in the setting of their choice; increase payment rates to promote recruitment and retention of direct care workers, increase wages, and develop and update training opportunities; and provide support to the Centers for Medicare & Medicaid Services (CMS) to conduct oversight and encourage innovation to benefit direct care workers and care recipients.
In March, Chairman Casey held a hearing to examine the economic benefit of investing in Medicaid HCBS as millions of older adults and people with disabilities nationwide rely on caregivers to provide help with activities of daily living despite caregivers earning a median wage of roughly $14 per hour. During the hearing, Casey introduced that the HCBS Relief Act would be introduced to address lengthy waiting lists for home care services. Read more about the legislation here.
Senator Introduces Disability Employment Incentive Act
On October 18, Senator Bob Casey (D-Pa.) introduced S.3076, the Disability Employment Incentive Act (DEIA), to encourage employers to hire and retain employees with disabilities. The bill enhances three existing tax credits to support employers who hire individuals with disabilities and make workplaces more accessible to those employees: the Work Opportunity Tax Credit; the Disability Access Expenditures Tax Credit; and the Architectural and Transportation Barrier Tax Credit.
The tax credits would provide incentives to small and large employers and not only encourage employers to hire, but to retain individuals with disabilities as members of their workforce. The DEIA will increase the tax credit for employers who hire a person with a disability referred to them through a state Vocational Rehabilitation agency, a person who is receiving Supplemental Security Income (SSI) benefits and a person who is receiving Social Security Disability Insurance (SSDI) benefits. The credit will continue to be 40 percent of the individual’s salary for the first year of employment, but raise the amount of the salary considered for credit from $6,000 to $12,500, raising the maximum available tax credit from $2,400 to $5,000. The DEIA also provides a tax credit for any business that retains an employee for a second year of employment and permits the business to take a credit on 20 percent of the employee’s salary up to $12,500, which is a $2,500 credit.
Lawmaker Introduces Bill to Expand P&A Services to Help with Transportation
In late September, Rep. Frederica Wilson (D-Fla.) introduced H. R. 5859, the Transportation Assistance for Individuals with Disabilities Act, that directs the Secretary of Transportation to establish a program to provide grants to protection and advocacy systems (P&A) to advocate for individuals with disabilities to access transportation. P&As were stablished in the 1975 Developmental Disabilities Assistance and Bill of Rights Act after investigations and reporting of the abysmal care provided in state institutions by the news media following researchers who also reported on these conditions. In 2000, the Traumatic Brain Injury Act (TBI) amendments authorized a similar advocacy program for individuals with TBI. Today, there are nine established P&A programs administered by several federal agencies, including the Department of Education, the Department of Health and Human Services, and the Social Security Administration.
HUD Designates Funding for People with Disabilities
The U.S. Department of Housing and Urban Development (HUD) announced that it is making $212 million available through the Section 811 Supportive Housing for Persons with Disabilities program. Half of the funds will go toward developing new or rehabilitating existing supportive housing for low-income people with disabilities and keeping it affordable. The remaining money will be used for grants to housing agencies to subsidize rental costs.
HUD and the U.S. Department of Health and Human Services (HHS) have also announced a joint project to support states in developing or expanding innovative housing-related supports and services for Medicaid-eligible people with disabilities and older adults who are experiencing, or at risk of, homelessness. The Partnership Accelerator will focus on helping states improve collaboration and coordination between organizations and systems that provide services and resources that help people find — and keep — stable housing in the community.
The Housing and Services Partnership Accelerator will bring interdisciplinary teams from four states together in a 12-month learning collaborative to tackle common issues, such as navigating payment models and rates, data integration and sharing, and more. Participating teams will include state Medicaid agencies, as well as state and community organizations focused on homelessness and housing, aging and disability, substance abuse, public health, and more. To be eligible, states must have a (Centers for Medicare & Medicaid Services-approved) Section 1115 demonstration project or Section 1915(i) state plan home and community-based services benefit covering housing-related supports for people experiencing, or at risk of, homelessness. (Sections 1115 and 1915 of the Social Security Act authorize programs that test ways to deliver and pay for health care services in Medicaid and the Children’s Health Insurance Program.) Letters of intent are due November 15, 2023 and final applications are due December 1, 2023.