Capitol building

Home- and community-based services are in the crosshairs as top Democrats look to pare down their ambitious healthcare proposals in the massive $3.5 trillion proposed budget.

Politico reported late Monday that lawmakers are looking to dramatically scale back the Biden administration’s call for $400 billion for HCBS. That should not come as a huge surprise to the home care industry. As far back as July, National Association for Home Care & Hospice President William Dombi told McKnight’s Home Care Daily he said the amount allocated for HCBS in the Better Care Better Jobs Act was closer to $150 billion, an amount Dombi still saw as a positive investment.

“You can’t look at $150 billion infused into home care and not smile,” Dombi said in July.. “It is one of the first investments of that kind in home care in many, many years and it sets the stage for a commitment to bring healthcare home to the greatest degree possible.”

The proposed $400 billion was originally earmarked for increased wages and benefits for home care workers and expanded services that allow seniors to age in their homes and communities. But the administration’s Build Back Better initiative has faced massive challenges as it moves through the House of Representatives.There has been pressure from moderate Democrats in both the House and Senate to shrink the size of the overall budget bill to get it through Congress.

HCBS funding isn’t the only budget item benefiting seniors that could get cut. Medicare expansion that would include coverage for dental, vision and hearing benefits is also coming under intense scrutiny.  

House Speaker Nancy Polosi said the House plans to vote on both the bipartisan infrastructure bill and the reconciliation package later this week.