Biden’s ambitious expansion of long-term care sparks debate
President Joe Biden is proposing a major expansion of the government’s role in long-term care, but questions are being raised over his using the low-income Medicaid program and piggybacking the whole idea on an infrastructure bill.
The White House infrastructure package includes $400 billion to accelerate a shift from institutional care to home and community services through the federal-state Medicaid program. The size of the financial commitment — about 17% of the $2.3 trillion infrastructure proposal — leaves no doubt that Biden intends to put his mark on long-term care.
Biden is acting as the nation emerges from a pandemic that has taken a cruel toll on older people, particularly nursing home residents. Long-term care was always going to be a growing issue in an aging society like the United States. The pandemic has made it even more consequential.
“The most important thing that Biden did is to say that ‘Long-term care is a major priority in my administration,’” said Howard Gleckman, a retirement policy expert with the Urban Institute think tank. “At the 30,000-foot level, this is really important because the president says so.”
Below that, the White House has not spelled out much. A summary of Biden’s plan says the money would go to expand home and community-based services so more people could get care. A major goal would be to raise pay and benefits for workers, nearly all of whom are women, many from minority and immigrant communities. Wages now average around $12 an hour. The proposal would also permanently reauthorize a program within Medicaid that
WASHINGTON —
President Joe Biden speaks about gun violence prevention in the Rose Garden at the White House, on Thursday. helps people move out of nursing homes and back into their communities.
But Medicaid remains a safety net program and that means middle-class people can face arduous challenges to qualify even if they have staggering expenses for long-term care. Because Biden is funneling his funding boost through Medicaid, that leaves out the middle class.
Biden “is the working-class guy, the middle-class guy ... he knows if we only focus on Medicaid, his core constituency is not going to be helped, unless they wipe out their assets,” said William Arnone, CEO of the nonpartisan National Academy of Social Insurance, which works on policy.
An alternative to Medicaid could resemble Social Security and Medicare, which have no income-based tests for benefits, Arnone added. But that would cost far more than Biden is proposing to spend. People often assume Medicare covers long-term care, but it does not.