A new bill seeking to expand and permanently fund home- and community-based service programs — including those provided in assisted living — is “exactly what’s needed” to begin to solve the aging services workforce crisis and ensure choice for older adults, according to industry experts.
The HCBS Access Act was introduced Thursday by Sen. Bob Casey (D-PA) during a Senate Special Committee on Aging hearing about increasing the nation’s supply of direct care workers. The bill is a companion to the Better Care Better Jobs Act that Casey previously introduced, which would encourage states to recognize and promote the benefits of assisted living as part of the continuum of care and include those settings in state HCBS plans.
The bill would eliminate the need for state HCBS waivers — under which many assisted living providers deliver HCBS services — to allow states to expand their capacity to meet the needs of those who prefer HCBS to nursing home care, address the workforce shortage, create quality measures for HCBS and increase Medicaid funding for HCBS.
Of special interest to senior living is that the bill would make the Medicaid program mandatory in all states, according to Jeanne McGlynn Delgado, American Seniors Housing Association of government affairs. That, she said, should increase access to assisted living settings for eligible older adults and no longer limit that access by geography.
The bill also proposed enhanced funding for state Medicaid expansions, as well as support for building and retaining the direct care workforce, Delgado told McKnight’s Senior Living.
“Assisted living is an important part of the HCBS continuum of care and, therefore, directing states to make this mandatory will bring equity to the program and improve the lives of seniors in those states that don’t have the option today,” Delgado said.
Many assisted living providers participate in the Medicaid HCBS waiver program in their states, offering an affordable senior living option to residents who otherwise could not afford a private pay setting. But Delgado said the business model is not for everyone, so the details of these reforms will be “very important.”
“Rather than target one or two areas, this legislation rightly aims to spread workforce resources widely,” LeadingAge President and CEO Katie Smith Sloan said in a statement. “And that’s not all — the expansion of home- and community-based services called for in this legislation is sorely needed to ensure that older adults can receive services in the setting of their choice, across the care continuum.”
Sloan said that under the proposal, state and nonprofit apprenticeship and training programs would be eligible for funding, along with retention initiatives that focus on helping aging services employees develop their skills on the job.
The bill would, over time, eliminate lengthy waiting lists for HCBS services and put HCBS providers on equal footing with skilled nursing facilities under Medicaid, ensuring that eligible older adults and people with disabilities have a choice of care and support options, Casey said during the hearing.
HCBS waitlists total approximately 700,000 people nationwide, and more than 80% of providers are turning away new referrals due to limited staff capacity.
In a proposed $6.8 trillion 2024 budget released Thursday, President Joe Biden called for $150 billion in funding for HCBS over the next decade. Sloan said the budget provides “sorely needed resources” for programs affecting older adults and their caregivers.
“The federal government, for the first time in decades, is committed to meaningful action to ensure America’s older adults and families can get the help they need,” she said. “We’re encouraged that the president’s public statements of support for older adults and families are reflected in the numbers released today.”
