President Joe Biden, with Vice President Kamala Harris talks about infrastructure investments. ... (Photo by Brendan Smialowski / AFP) (Photo by BRENDAN SMIALOWSKI / AFP via Images)
AFP via Images President Biden for people receiving services and Long Term Supports (LTSS) has already achieved a major goal: Policy makers and opinion leaders are talking about how we care for frail older people and young people with disabilities.
We haven't had a conversation about long-term care like this since Congress created Medicaid over half a century ago. Certainly, there have been and even conferences at the White House that have raised the profile of long-term care. But nothing compares to an actual presidential proposal - especially one worth $ 400 billion.
But as this debate intensifies, it is essential that decision-makers remain focused on what really matters: how society can best help those in need of personal supportand their families. To do this, they must avoid being distracted by political noise and talking points that are already confusing the discussion.
Listening to the debate to come, here are some important questions and other political blather.
Is this an infrastructure? Biden included his Medicaid HCBS proposal in the US Jobs Plan, which he billed as a $ 2 trillion pl US infrastructure package. This immediately sparked a debate on expanding a public support program for low-income people in long-term care. Short answer: who cares? Supporters of Biden's plan should not be taken in by this argument. And reviews should focus on merits, not labels. Unless, of course, they are afraid of losing on the bottom.
Is $ 400 billion enough? A good question. Even in Washington, $ 400 billion is a lot of money, but what will he buy? Biden's plan leaves out almost every detail. He's just saying he wants the federal government to spend an additional $ 400 billion over eight years to expand Medicaid's HCBS program and support home care workers. But how? Even with $ 50 billion a year, it will have to balance a higher salary for aid, more benefits for existing beneficiaries, and increased access to Medicaid LTSS for those who are not yet eligible.
Is it well targeted? A better question. It is undoubtedly important to support the very poor and those who care for them. But there are millions of middle-income Americans who will never be poor enough in.ur qualify for Medicaid LTSS but cannot afford long term care. Biden offers to do nothing for them. A would support these seniors, give them much more choice in how they design their care, and reduce the future burden of Medicaid.
What about non-Medicaid supports? For many people living at home, Medicaid is not enough. They still need affordable and safe housing, transportation, home delivered meals, adult day services and more. These programs are. Will Biden also increase his funding?
Who is “behind” the plan? The Wall Street Journal (paywall) the proposal because it is at the behest of the International Union of Service Employees that wan to organize home care workers. And Biden's proposal says that these workers should haver the right to organize. But let's not be naive, the expansion of Medicaid HCBS will generate intense lobbying from all quarters: home care agencies, nursing home operators, unions and advocates for people with disabilities and the elderly. We should be less interested in the origin of an idea than in its merits. In an attempt to arouse corporate opposition to the plan, some critics want to engage in a pro and anti-union debate. But it would be a shame if that masks the problem of providing care to those who need it most.
What does this mean for retirement homes and assisted living facilities ? Biden has sent a strong and explicit signal: He sees the future of Medicaid long-term care largely in home care. But hundreds of thousands of Medicaid LTSS recipients cannot live safely at home and will need support.me of institutional care. I guess long-term care home advocates will do whatever they can to get a share of Biden's $ 400 billion. And some should. The question is: how can the government better link payment to quality and ensure that the money goes to the facilities that will use it to improve care, not to increase their outcomes?
