President’s Budget Includes $400B Home Care Investment

Situation Report | June 7, 2021

President Biden advanced his $6 trillion federal budget proposal to Congress on May 28.

In addition to spending across programs and overall administrative functions of the federal government, the budget includes several major new initiatives that were earlier presented as part of the President’s infrastructure plan and his proposal to build on the federal relief package from earlier this year.

Foremost among these is an investment of “$400 billion in home- and community-based services for older people and people with disabilities and strengthening the workforce that provides this vital care,” the President’s summary document says. This component of the budget was already advanced alongside many other areas of the President’s infrastructure plan, such as proposed investments in affordable housing, roads, bridges, broadband, the power grid, and public works.

Few details have emerged about the President’s home care proposals specifically. The Administration says its plan “would provide home and community-based care for individuals who otherwise would need to wait as many as five years to get the services they badly need.”

It adds: “The President also looks forward to working with the Congress on other policies to improve economic security and access to healthcare for seniors and people with disabilities.”

The President’s overall funding recommendations in the budget are for fiscal year (FY) 2022, which begins on October 1. As recommendations, the budget requires negotiations and action from Congress. And while Democrats hold majorities in both houses, a 60-vote threshold is needed to overcome a GOP filibuster in the Senate.

In a sign of what’s in store for upcoming negotiations, Senate Republicans have advanced a much smaller counterproposal to the President’s infrastructure package. It does not include the President’s home care provisions and focuses on what might be characterized as traditional infrastructure projects, like roads and bridges.

Other Health Care Components of the Budget

As far as other health care items, the President’s budget calls for “expanding and improving” the Affordable Care Act, Medicaid, and Medicare coverage.

On Medicare, the President’s budget briefing document points to “evidence show[ing] that we can reform Medicare payments to insurers and certain providers to reduce overpayments and strengthen incentives to deliver value-based care,” suggesting a possible focus on Medicare payment reform.

The President also highlights proposed funds for pandemic preparedness, increased access to mental health services, maternal health and health equity, $1.8 billion to fund health workforce programs, drug pricing reforms, rural health care investments (including $37 million for telehealth and $165 million for the rural community opioid response program), behavioral health and substance abuse, and more.


The budget also mentions a focus on organized labor, though the details and applicability to health care are not known. The administration’s briefing document refers to “ensuring workers have a free and fair choice to organize, join a union, and bargain collectively with their employers.”

Home Care First

As we’ve previously noted, 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.

HCA will be examining the President’s proposals in further detail and urging a broad applicability of proposed home care infrastructure investments across a range of targeted areas supporting New York’s home care system.