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Casey touts provisions in America Rescue Plan

$730M slated to enhance the pay of home and community-based care workers

The recently adopted American Rescue Plan contains two provisions placed by U.S. Sen. Bob Casey, allocating a total of $13.4 billion to help older people and people with disabilities, the senator said in a virtual news conference Thursday.

One provision provides $12.7 billion for home and community-based services, so seniors and people with disabilities can get needed help at home, rather than in nursing homes and other institutions; while the other provision provides $700 million to help nursing homes deal with COVID-19.

The first provision would help shrink Medicaid waits lists for home and community-based care, according to officials.

Currently, 4.2 million seniors and people with disabilities receive home and community-based services, including 135,000 Pennsylvanians, but the wait lists are large: 800,000 nationally, including 16,000 in Pennsylvania, according to information provided by Casey.

The default funding for Medicaid is for institutional care, and obtaining home care requires the granting of a “waiver” by the federal government for states to use program funding for “in-home care for people who would otherwise have to go into long-term institutional care,” according to assistedliving.org.

“This means they can stay in their own home or a community setting (such as a relative’s home or a supported living community) instead of going into a nursing facility,” the assistedliving.org states.

The preference “by way of policy and funding” is for institutional care — as indicated by the need for a waiver to have that money go to home and community care — but the actual preference of users has swung away from institutional care, according to Nancy Thaler, former deputy secretary for the Office of Developmental Programs under the Department of Human Services.

The statistics show evidence of that preference: as of 2014, 53% — $80.6 billion — of Medicaid long-term care spending was on home and community based services, according to medicaid.gov.

People in need of this Medicaid-funded help should be able to get it, and they shouldn’t have to wait months or years, Casey said.

Waiting for a waiver to come through can mean a year at home “on the couch” for young adults eager to transition from high school to the community and to “put their life together,” said John Seeley, director of Empowering Lives Foundation in Altoona, a panelist in the news conference, along with two of his clients.

Yet $12.4 billion is far short of the “couple hundred billion” necessary to really “make this work,” Casey said.

About $730 million of the $12.4 billion is slated for Pennsylvania, Casey said.

The overall allocation will include funding to enhance the pay of workers who provide home and community-based care, and to provide those workers with the proper personal protective equipment, Casey said.

“We cannot continue in the U.S.A. paying these workers — mostly women of color — $12 an hour,” Casey said.

Such pay is not “commensurate” with the value the nation places on the help those workers provide to vulnerable people — help that has placed those workers at risk during the pandemic, Casey said.

“The pay and benefits should reflect the gravity and significance of that high calling,” he said.

The “solid” legislation represented by the money that will cut into the waiting list is something she never thought she’d see, Thaler said.

“This will cure a lot of problems,” she said.

The second Casey provision in the American Rescue Plan provides $500 million for “strike teams” to help manage COVID-19 outbreaks in nursing homes and to deal with staff shortages, and it also provides $200 million to promote best practices in infection control, along with vaccination programs in nursing homes.

Congregate settings have accounted for 181,000 COVID-19 deaths in the U.S., according to information provided by Casey’s office.

“Infection control predates the pandemic,” Casey said. “(And) it will remain an issue.”

Mirror Staff Writer William Kibler is at 814-949-7038.

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