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In a 2022 report, over 70 percent of direct service providers reported they cannot fill staffing vacancies for home care

As a result, 83 percent of providers said they turn away new referrals and 63 percent have discontinued some programs and services

Washington, D.C. – Today, U.S. Senator Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging, led a group of 17 of his Democratic colleagues in introducing the Home and Community-Based Services (HCBS) Relief Act, legislation to provide much-needed 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, despite growing demand. 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. 

“A vast majority of seniors and people with disabilities would prefer to receive care at home or in their communities,” said Chairman Casey. “Unfortunately, because of our Nation’s caregiving crisis, home and community-based care has become increasingly difficult to access. By stabilizing and investing in the caregiving workforce, we can better provide seniors and people with disabilities with a real and significant choice to receive care in the setting of their choosing.” 

More than 90% of those eligible for Medicaid long-term services and supports wish to receive those services in their homes. However, HCBS providers are struggling to meet the demand for their services due to extreme difficulty retaining staff and filling new vacancies. 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. 

Chairman Casey has a long record of advocating for increased federal support for state-funded home and community-based long-term care 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 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 home and community-based services (HCBS) as millions of older adults and people with disabilities nationwide rely on caregivers to provide everyday services like help with bathing, eating, and managing medications despite caregivers earning a median wage of roughly $14 per hour and often living in poverty. During the hearing, Casey introduced the HCBS Access Act to address lengthy waiting lists, that sometimes last years and even decades, for home care services as the majority of older adults and people with disabilities contend with being forced to live in an institutional setting to access the services they need due to long wait lists, despite a preference for receiving care at home.  

Read more about the Home and Community-Based Services (HCBS) Relief Act here.