Howard Gleckman

The Biden administration’s $400 billion effort to boost home- and community-based services is “ambitious,” but still missing critical pieces towards fully reforming Medicaid’s long-term care coverage, a leading expert is warning.

President Joe Biden unveiled his $2 trillion American Jobs Plan last week, which calls for the boost to HCBS as a critical investment in the nation’s aging infrastructure. Long-term care providers followed the move with an outline of their own on how federal lawmakers can support the building of a better aging infrastructure.

Finance expert and Forbes columnist Howard Gleckman noted that although the proposal aims to tackle worthy causes, such as Medicaid HCBS waiting lists, and expand access to those services while also creating better jobs for caregivers, these goals conflict with one another. 

“The problem, of course, is that given a finite amount of money, all these laudable goals conflict with one another. The more direct care workers are paid, the fewer hours of care they can deliver. The more services Medicaid provides to currently eligible beneficiaries, the fewer resources it has to expand the program to more people,” Gleckman wrote in a Thursday column.

He also noted there are still several missing pieces not proposed in the plan. Those issues include more support for the Money Follows The Person initiative, affordable housing and installing a fully-funded public long-term care insurance program. 

“These objections aside, Biden has taken a giant step towards reforming Medicaid’s dysfunctional system of long-term care — failures that were laid bare by the COVID-19 pandemic,” Gleckman wrote. 

“It will be an enormous step forward for those with long-term care needs and their families if, at the end of the day, Biden’s new funding for Medicaid HCBS is part of the final plan,” he concluded.