MAX RICHMAN PRESIDENT AND CEO
NATIONAL COMMITTEE TO PRESERVE SOCIAL SECURITY AND MEDICARE
STATEMENT FOR THE MARCH 23, 2022 HEARING RECORD ON “AN ECONOMY THAT CARES: THE IMPORTANCE OF HOME-BASED SERVICES”
THE SPECIAL COMMITTEE ON AGING UNITED STATES SENATE
On behalf of millions of our members and supporters, I commend the Senate Special Committee on Aging’s important work related to improving access to home and community-based services (HCBS) for seniors and people with disabilities.
The COVID-19 pandemic has dramatically underscored what decades of research on infection control and beneficiary preference already made clear: nursing homes are often dangerous for residents and staff. According to the Government Accountability Office, 82 percent of surveyed nursing homes had an infection prevention and control deficiency between 2013 and 2017. As of February, 200,000 nursing home residents or staff died of COVID which is nearly one quarter of all COVID-related deaths in the United States. It is abundantly clear that seniors are safer in their homes where approximately 75 percent of seniors wish to live as they age.
Despite all that we know about nursing home deficiencies, 820,000 Americans are on wait lists for Medicaid home and community-based services. Without access to Medicaid HCBS the only option for people who can’t afford to pay for long term care out of pocket is a nursing home.
Given that seniors continue to be vulnerable to COVID even with vaccination, there is an urgent need to extend and enhance funding for home and community-based services created by the American Rescue Plan Act (ARPA), including wage and benefit increases for home care workers to help recruit and retain them. State Medicaid programs have used these COVID-19 public health emergency (PHE) authorities and funding to:
- Expand eligibility criteria for seniors and people with disabilities
- Streamline enrollment processes
- Reduce premium and cost sharing requirements
- Improve provider payment rates
These emergency funds, which are currently bolstering home care services for seniors, will run out when the public health emergency ends. The National Committee is concerned that without resources for home-based long-term services and supports, seniors will be forced back into the same institutional settings that proved so deadly over the course of the pandemic.
Moreover, there is evidence that shifting people out of nursing homes and back into their homes can save money. One study found that a gradual shift away from institutional care to home based services could reduce long term care spending by 15 percent.
For this reason, the National Committee strongly supports Chairman Bob Casey’s legislation, S. 2210, the Better Care Better Jobs Act, which would provide a permanent enhanced funding stream for Medicaid HCBS and make the “Money Follows the Person” rebalancing demonstration program and spousal impoverishment protections for Medicaid HCBS permanent.
The National Committee continues to support improving access to Medicare’s home care benefit and creating a long-term care benefit that beneficiaries who are not Medicaid eligible can access. It is a shame that so many of our seniors must impoverish themselves to access long term care benefits when they outlive their savings. We look forward to working with members of the Senate Special Committee on Aging to improve long term services and supports for seniors so that they can more safely age with dignity in their homes.
Thank you again for holding this timely and important hearing.