Rep. Dingell: US Needs More Home Care For Medicaid Recipients, Better Worker Pay

U.S. Rep. Debbie Dingell, D-Dearborn, wants Congress to provide states more funding in the future to expand home and community-based care to Medicaid recipients and to make sure the people providing those services are better paid.

On Thursday, she introduced legislation that, if enacted, would do that. An identical bill was also introduced in the U.S. Senate.

Home and community-based programs in Michigan and other states allow people who otherwise might need to be moved into nursing facilities because of their health to remain home or receive services in community centers. But there are hundreds of thousands of potential recipients on waiting lists across the U.S. for those services and reports of home health care workers living near the poverty line.

"No one should have to wait to get the care they deserve and no care worker should have to live below the poverty line," Dingell said. She added that she was lucky that when her late husband, former Rep. John Dingell, needed home care, they had insurance coverage that allowed him to get it. John Dingell died in 2019.

"That experience also shed light on the challenges in our long-term care system, from low wages for workers to thousands on HCBS (home- and community-based services) waitlists. We need a stronger system," she said.

In Michigan, some 90,000 people receive home and community-based Medicaid services. About 3,000 people are on waiting lists to receive that aid.

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The legislation would continue a funding mechanism included in President Joe Biden's COVID-19 relief plan passed earlier this year. That measure included $12.7 billion to increase the federal match to states for Medicaid costs by 10% if the amount of the increase went to expand home and community services for Medicaid recipients or to hike pay for providers. That measure and its funding, however, expires next year.

Each state's matching rate is set according to its average per capita income compared to the rest of the country. Michigan's rate is just under 72%.

In order to receive the funding into the future under Dingell's legislation, a state would need to commit the additional funding it would receive to expanding its home and community-based services under Medicaid. Examples of how it could do so would be  lowering income limits to receive those services, allowing working people with disabilities to access those programs and adding additional help for family caregivers.

It also requires states "address insufficient payment rates for delivery of home and community-based services, with an emphasis on supporting the recruitment and

retention of the direct care workforce" and says those rates should be reviewed every two years.

Dingell's office said the 10-year cost would be about $400 billion, basing that on a similar proposal Biden made in his infrastructure proposal. The legislation may face a tough road to passage if Republicans, as expected, object to it, however. While it could pass in the House, it would have to be included in specific budgetary legislation in the Senate that would require a simple majority vote in that chamber rather than the 60-vote threshold often needed. The two parties are split 50-50 in the Senate, with Vice President Kamala Harris able to break ties.

Contact Todd Spangler at [email protected]. Follow him on Twitter @tsspangler. Read more on Michigan politics and sign up for our elections newsletter.

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