WASHINGTON (AP) – President Joe Biden is proposing a major expansion of the government’s role in long-term care, but questions are being raised over his using the low-income Medicaid program and piggybacking the whole idea on an infrastructure bill.
The White House infrastructure package includes $400 billion to accelerate a shift from institutional care to home and community services through the federal-state Medicaid program. The size of the financial commitment – about 17% of the $2.3 trillion infrastructure proposal – leaves no doubt that Biden intends to put his mark on long-term care.
Biden is acting as the nation emerges from a pandemic that has taken a cruel toll on older people, particularly nursing home residents. Long-term care was always going to be a growing issue in an aging society like the United States. The pandemic has made it even more consequential.
“The most important thing that Biden did is to say that ‘Long-term care is a major priority in my administration,'” said Howard Gleckman, a retirement policy expert with the Urban Institute think tank. “At the 30,000-foot level, this is really important because the president says so.”
Below that, the White House has not spelled out much. A summary of Biden’s plan says the money would go to expand home and community-based services so more people could get care. A major goal would be to raise pay and benefits for workers, nearly all of whom are women, many from minority and immigrant communities. Wages now average around $12 an hour. The proposal would also permanently reauthorize a program within Medicaid that helps people move out of nursing homes and back into their communities.