Biden Proposes $400B Investment in Home and Community Care as Part of Infrastructure Plan

Situation Report | April 5, 2021

Among $2 trillion in investments, President Biden’s newly announced infrastructure plan calls for a $400 billion plan over eight years to expand home and community-based care options.

At no other time since probably the 1981 home and community-based Medicaid waiver program has a national agenda of home care investment been so prominent; and it comes at a time when HCA’s Home Care First agenda calls for a new level of state and national commitment to home care investment.

Much still depends, however, on further details of the President’s now-broadly outlined proposals, which HCA and partners nationally are eager to see.

According to a fact sheet, the President is calling for funds to expand access to Medicaid home and community-based services (HCBS) and extend the Money Follows the Person program. The President’s summary document also includes a strong emphasis on worker wages and unionization, proclaiming support for “well-paying caregiving jobs that include benefits and the ability to collectively bargain.”

President Biden discussed home care and the caregiving economy extensively during his campaign, at that time pledging a $775 billion plan for investments. The President has noted that 800,000 individuals are now on waiting lists for home and community-based care. As HCA’s own reports have shown, a long-term trend of growing demand for home care is especially high in the pandemic, though providers face the continued challenge of chronic workforce shortages and the need for further infrastructure investments in services and personnel to meet demand.

Over the past decade, the number of New York’s residents aged 65 and older has grown 26 percent, compared to an overall population that grew just 3 percent during the same period, HCA notes in our most recent 2021 State of the Industry report: “The growing population of adults over 65 will continue to drive the need for home care workers at a time of acute shortages, intensified by the public health emergency and existing longstanding shortages,” we write. Nationally, meanwhile, the number of people aged 85 and older is projected to nearly triple from 6.7 million in 2020 to 19 million by 2060.

Biden administration officials have cited similar statistics as a basis for the President’s proposals.

The President’s overall infrastructure plan includes many other areas of investments, from affordable housing to roads and bridges, broadband, the power grid, and public works. The administration said it hopes advance the plan in Congress by the summer, though the President’s proposals face an uphill climb in Congress, particularly in the closely divided Senate. Sixty votes are needed to overcome a filibuster, though it is unclear whether Senate Democrats may seek to bypass that constraint through a process called “reconciliation” — a maneuver which lawmakers leveraged in the most recent stimulus package — to pursue passing the President’s plan, or part of it, on a simple majority vote.

HCA will report back to the membership as we learn more and as we convey our position to the Biden administration and Congress on specific approaches for home care investment.