Reimagining Care: Biden’s Bold Vision for Home and Community-Based Services

Medicaid home and community-based services expansion"
Reimagining Care: Biden's Bold Vision for Home and Community-Based Services

In a landmark moment during his State of the Union address, President Joe Biden emphatically underscored his commitment to overhauling the nation’s home and community-based services (HCBS) system. This initiative, aimed at transforming care for individuals with disabilities, marks a pivotal stride toward fostering a more inclusive and supportive society.

As we dissect Biden’s address, it’s clear that the administration’s agenda is not only about enhancing the quality of life for those with disabilities but also about acknowledging and elevating the essential workers in this sector. By advocating for significant investments in HCBS, Biden is addressing a critical gap in our healthcare system—the need for comprehensive, in-home care that supports both the recipients and the caregivers.

The President’s call to Congress was unequivocal: “Let’s get seniors who want to stay in their homes the care they need to do so. Let’s give more breathing room to millions of family caregivers looking after their loved ones.” Here, Biden is not just proposing a policy change; he is championing a shift in how we perceive and value care in our communities. It’s about granting dignity and autonomy to our most vulnerable populations and recognizing the unsung heroes in the caregiving profession.

However, this noble vision has faced its share of legislative hurdles. Despite Biden’s ambitious proposal to allocate $400 billion toward Medicaid HCBS—aiming to eradicate waiting lists and bolster the direct support workforce—the initiative has been met with resistance and reductions in Congress. The House of Representatives’ approval of a trimmed $150 billion for the program in late 2021 highlights the challenges of turning visionary policy into actionable change. This measure subsequently stalled in the Senate.

The introduction of the “Better Care Better Jobs Act” by federal lawmakers last month, seeking a permanent increase in federal Medicaid matching funds for HCBS, represents a renewed effort to realize Biden’s plan. This legislative push reflects a growing recognition of the sector’s challenges, notably the dire shortage of direct support professionals—a crisis further amplified by the COVID-19 pandemic.

The stark realities faced by disability service providers, as revealed in recent surveys, underscore the urgency of Biden’s call to action. With a majority of providers unable to accept new referrals and forced to cut back on programs due to staffing shortages, the human cost of inaction is too high.

David Goldfarb, Director of Policy at The Arc, affirms that Biden’s spotlight on HCBS during the State of the Union sends a potent message to Congress and the nation. By addressing the systemic issues plaguing the care sector, including inadequate compensation for caregivers, Biden is laying the groundwork for a more equitable and accessible care system.

Moreover, the President’s broader agenda, touching upon paid family leave, the restoration of the full child tax credit, and access to affordable childcare, paints a comprehensive picture of his commitment to strengthening the social safety net for all Americans, particularly those with disabilities and their families.

As we reflect on Biden’s address, it’s evident that the path to reforming home and community-based services is fraught with legislative and societal challenges. Yet, the President’s unwavering commitment to this cause is a beacon of hope for millions. It reminds us that at the heart of policy are people—individuals with disabilities, caregivers, and families whose lives and futures depend on the courage and will to enact meaningful change.

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