Bloomberg Law
March 9, 2023, 10:00 AMUpdated: March 9, 2023, 2:42 PM

‘Caregiving Crisis’ Spurs Democrats’ Push for Home Medicaid (1)

Alex Ruoff
Alex Ruoff

A group of Democrats are renewing their push to expand Medicaid coverage of home health services.

The lawmakers, led by Sen. Bob Casey (D-Pa.) and Rep. Debbie Dingell (D-Mich.), will introduce a bill Thursday to require states to cover home health services on par with nursing homes, and greatly expand federal reimbursement for it, according to an outline of the legislation shared with Bloomberg Government.

“The caregiving crisis in this country leaves millions of seniors and people with disabilities without a meaningful choice of where they can receive essential, life-sustaining care,” Casey said in a statement. “It corners many family caregivers into upending their careers and living on poverty wages or performing unpaid work because they have no other options.”

Bolstering home health services—which include personal assistance with daily activities and transportation, as well as at-home nursing care—could also be a major jobs program for home-care workers, supporters say.

Sen. Bob Casey speaks at a home care workers rally and march on Nov. 16, 2021 in Washington.
Jemal Countess/Getty Images for SEIU

“This is one of the fastest-growing industries in the country,and this workforce is among the fastest-growing,” said Ai-jen Poo, president of the National Domestic Workers Alliance and a founder of Caring Across Generations, both labor groups backing the measure.

Both Casey and Dingell sought to expand Medicaid coverage of home health as part of the sweeping domestic policy package passed with just Democratic votes in the last Congress (Public Law 117-169). But such expansion is pricey—it would put billions of dollars into states to boost worker pay and cut down waiting lists for at-home care for people with disabilities and the elderly.

The US overall spent $286 billion for home- and community-based services in 2020—which are used to help seniors and people with disabilities with tasks such as preparing meals, bathing, dressing, and managing medication or mobility, figures from the Kaiser Family Foundation show. Medicaid paid for more than half of the total, despite the service being optional for states to offer.

Read More: Worker Shortage Hampers Biden’s Expansion of Home Health Care

Long Waitlists, Low Pay

Despite this large spending overall, home health workers make on average about $29,000 per year, according to data from the Bureau of Labor Statistics. Almost a quarter of home health and personal care workers are immigrants, the data show.

Every state offers versions of home-care options for those on Medicaid, but 37 states had some kind of waitlist in 2021, according to the Centers for Medicare and Medicaid Services. The number of people on waiting lists in 2021 stood at 656,000, the KFF data show.

“Long-term care is a real crisis in this country,” Dingell said in an interview.

Casey said that with some people forced to leave the workforce to care for family members, his goal is eliminate these waitlists, giving everyone access to home health care.

Home-care spending has only increased in recent years and new federal funds are needed to meet growing demand, Poo said. The American Rescue Plan Act (Public Law 117-2) offered states a higher Medicaid reimbursement to boost pay for home health workers or expand access to the service. All 50 states took the money, she said, even though the funds are set to largely dry up this year.

Earlier: Aging Population Faces ‘Backward Slide’ on Home Health Expansion

“There’s interest in red and blue states,” Poo said.

The legislation has no Republican backers. Conservatives unanimously opposed bills such as the American Rescue Plan Act over their higher federal spending. Dingell said she’s working to get Republicans on board with the legislation but declined to name any who support it.

Poo said this year her groups are making the case to Republicans in particular that funding for home care would bolster the US economy and be an “industrial policy” that improves the home-care workforce.

(Adds Rep. Dingell comments in paragraphs 10 and 14. A previous version fixed the parity comparison in the second paragraph.)

To contact the reporter on this story: Alex Ruoff in Washington at

To contact the editors responsible for this story: Robin Meszoly at; Anna Yukhananov at; Loren Duggan at