President Biden Appears to Tout Looming ‘80-20’ Home Care Rule in Campaign Speech

Home Health Care News | By Andrew Donlan
President Joe Biden made remarks on the care economy – including home care – in a speech Tuesday at Union Station in Washington, D.C.
“You know, take home care,” he said. “The cost of long-term care for aging loved ones and people with disabilities rose 40% in the last decade. Medicaid offers help, but it can’t meet the demand. You know, there are 700,000 seniors waiting in line — 700,000 waiting in line, and people with disabilities are stuck on Medicaid home care waiting lists for as long as 10 years if they survive to be qualified. It’s amazing. Think about it.”
Biden at first honed in on family caregivers, saying that “no one should choose between caring for a parent who’s raised them, a child who depends on them, or a paycheck that they need.”
Then, he pivoted to home- and community-based services (HCBS) workers, evoking the looming “80-20 rule,” which would force HCBS providers to direct 80% of reimbursement to care workers. 
That rule, which was proposed last year, has drawn heavy criticism from home care providers, who believe that the rule will hurt smaller providers and disproportionately affect providers based on which states they’re operating in. 
A final rule is expected some time this month, and it appears Biden’s administration will be moving forward with some version of the proposed rule. 
“In the coming weeks, we plan to release new rules to strengthen staffing standards in nursing homes, to get home care workers a bigger share of Medicaid payments,” Biden said.
The president also said that his administration would work to reduce waitlists for Medicaid HCBS. 
“Seniors and people with disabilities, we’re going to expand Medicaid home care services and reduce that 700,000-person backlog,” he continued. “That’ll mean more folks can live and work in their own communities with dignity and independence. More home care workers will start getting a better pay and benefits and dignity they deserve.”
Katie Smith Sloan, the president and CEO of the advocacy organization LeadingAge, highlighted some of the home care industry’s gripes with the Biden administration’s approach after Tuesday’s speech.
“For the first time in decades, our federal government is committed to meaningful action to ensure America’s older adults and families can receive quality care in nursing homes, and in their homes and communities,” Sloan said in a statement. “LeadingAge and our nonprofit, mission-driven aging services providers share the Biden Administration’s goal. Caregivers, as the president noted, are critical; without staff, as our nonprofit mission-driven members know, there is no care. Yet, unfortunately, the administration’s approach misses the mark.”
While the Biden administration may believe that better pay will lead to more workers, and thus more home access, advocates and providers disagree. 
“First, on the goal of ensuring more Medicaid dollars go to the home care workforce, via the proposed Medicaid Access Rule,” Sloan continued. “While well-intentioned, the ‘80-20’ provision … will likely reduce, rather than increase, older adults’ access to care and services.”
LeadingAge estimates that state rates for HCBS would need to increase by 45% – on average – for the 80-20 provision to be sustainable. Providers would need to cut their non-caregiver expenses by two-thirds otherwise. 
“We expect that the rule, if implemented as proposed, will lead to provider closures and exits from the sector,” Sloan said. 
LeadingAge urged the president and his administration to take a more “broad” and wide-ranging approach to senior care needs. 
“Imagine what we can do — imagine what we can do for America,” Biden said. “Look, folks, imagine a future with affordable childcare, home care, eldercare, paid leave.”