Gutted Version of Biden’s ‘Build Back Better’ Plan Still Includes $150 Billion for In-Home Care

President Joe Biden on Thursday went to bat for a significantly trimmed down version of his Build Back Better plan, a massive economic proposal that seeks to expand the country’s social safety net.

“No one got everything they wanted, including me,” the president said in his public remarks. “But that’s what compromise is. That’s consensus. And that’s what I ran on.”

Biden’s update came as the White House unveiled a drastically revised framework for Build Back Better that omits several original goals, including paid family leave and tools to lower drug costs.

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The new framework, revised in an effort to achieve full Democrat support, also leaves out free community college and an expansion of the Medicare program.

One thing the $1.75 trillion framework doesn’t leave out: funding for in-home care for America’s older adults.

“The Build Back Better framework will permanently improve Medicaid coverage for home care services for seniors and people with disabilities, making the most transformative investment in access to home care in 40 years, when these services were first authorized for Medicaid,” a White House outline explains.

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Specifically, the plan will carve out $150 billion to help reduce waiting lists for in-home care services and improve pay for low-wage in-home care professionals.

A substantial portion of Biden’s public remarks discussed the importance of home-based care, both for seniors and individuals with disabilities. At one point, the president said his home care agenda is “more popular or as popular as anything else we’re proposing.”

“For millions of families in America, this — this issue — is the most important issue they’re facing. It’s personal,” he said. “So here’s what we’re going to do. We’re going to expand services for seniors so families can get help from well-trained, well-paid professionals to help them take care of their parents at home — to cook a meal for them, to get their groceries for them, to help them get around, to help them live in their own home with the dignity they deserve to be afforded.”

As a candidate, Biden proposed spending $400 billion on home- and community-based services (HCBS) to help make up for years of underinvestment.

While $150 billion is less than half of that total, it’s still an important step toward achieving “fundamental change in long-term care policy,” according to the Partnership for Medicaid Home-Based Care (PMHC).

“The home care workforce has been undervalued and under-appreciated since the inception of HCBS services,” the advocacy organization said in a statement shared with Home Health Care News. “The $150 billion investment in HCBS will provide the opportunity for higher wages and increased standard of living for the direct care workforce, and other HCBS workers.”

The National Association for Home Care & Hospice (NAHC) likewise expressed support for Thursday’s framework.

“The home care community extends its great appreciation for the support of Medicaid HCBS and looks forward to reviewing all the details of the plan,” NAHC President William A. Dombi said in a statement shared with HHCN. “It is gratifying to see this strong recognition of the importance and value of home care.”

In addition to $150 billion for home-based care, the revised framework includes $150 billion to increase the supply of affordable housing and $130 billion to provide tax credits for up to 4 million uninsured people in states that have not expanded Medicaid benefits under the Affordable Care Act.

The framework also sets aside $1 billion for direct care workforce competitive grants, plus $20 million for hospice and palliative nursing programs.

Katie Smith Sloan, president and CEO of LeadingAge, described the Build Back Better investments as a “historic step to address the critical needs of older Americans and their families.”

Still, she suggested, there’s more work to do.

“We can’t let up now,” Sloan said. “The number of Americans 65 and older will more than double over the next 40 years, and half of us will need long-term services and supports as we age. Without further investments in our aging services infrastructure, too many older adults will not have their basic needs met.”

It’s still extremely uncertain whether Democrats have enough support to pass the Build Back Better framework, especially among progressive members of the party.

To complicate matters further, some lawmakers want to pass the social spending package simultaneously with a roughly $1 trillion infrastructure bill.

The social spending package was originally pitched to be a more than $3 trillion investment in climate change mitigation, caregiving, support for families and more.

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