Millions of seniors enrolled in Medicare would miss out on the expanded access to in-home care benefits proposed in the Biden administration’s $ 400 billion plan to boost the caregiving industry.
The administration’s $ 2 trillion infrastructure package, called the American Jobs Plan, would use $ 400 billion to expand access to in-home care under Medicaid, the government insurance program for the very poor and people with disabilities, in a way that meant is to support well-paying jobs for caregivers. But the plan does not address the lack of coverage for many in-home care services under Medicare, the government-funded health insurance program for those age 65 and older.
President Joe Biden campaigned on a similar plan to spend even more money, $ 50 billion more, to shore up Medicaid funding for states.
“It will be a huge benefit to a lot of people, but at the same time, it is our hope that Medicare becomes part of that conversation,” said David Lipschutz, associate director of the Center for Medicare Advocacy. “It would include Medicaid eligibility criteria, which would leave a good number of people out.”
Medicaid covers a wide variety of in-home care services such as physical therapy, medication administration, and daily housekeeping tasks. Seniors who qualify for Medicare make up the largest share of people who seek care at home, yet Medicare does not offer comprehensive coverage for its enrollees. Medicare beneficiaries are covered for part-time healthcare services performed in their homes, but not for continued care at home that consists of housekeeping, cooking, bathing, and other daily tasks. Seniors who only need in-home personal care have to pay out of pocket for a private care provider that would not be subject to federal oversight.
“It’s difficult for the federal government to monitor or to have any influence on the quality [of private care],” said Gretchen Jacobson, a Medicare policy expert at the Commonwealth Fund. “If it was covered by Medicare, then there could be more checks on the standards and quality of care.”
Jacobson added that extending coverage for a wider range of home care services to Medicare beneficiaries could be accomplished by the Biden administration “with help from congressional action.” Still, Biden has made no indication that he will propose such an extension in this or a future infrastructure package.
The Biden administration has shared a paucity of details about the American Jobs Plan, including how increased Medicaid funding would be allocated to states and what terms and conditions, if any, states would have to follow when spending the money.
“We hope that Medicare becomes part of this discussion and that Medicare becomes part of the vehicle for an expansion of long-term care,” Lipschutz said. “This will undoubtedly help if it expands access to this kind of coverage. We would like that expansion to include the Medicare program as well.”
The Biden administration is expected to introduce a “social infrastructure” package in the coming weeks, which will address more issues related to access to healthcare, child care, and quality education. The White House did not respond to requests for comment about the possible inclusion of expanded Medicare coverage for in-home care services.