Through Medicaid, Iowa provides a variety of direct care, home and community-based services to seniors and those with disabilities who qualify for Medicaid. Many are funded under Medicaid waivers to provide different populations of Iowans with specific conditions with alternatives to nursing home or other institutional care. This represents one of the major sources for financing Iowa caregivers to assist and enable seniors and persons with disabilities, including children, to live in dignity in their homes and participate in community life -- but the home and community-based services currently cover only a portion of those who could benefit from such care
Within the American Rescue Plan Act of 2021, Congress and the President provided additional funding for home and community-based services under Medicaid for states to expand those services as part of initial actions to expand investments in the overall direct care workforce. The funding requires states to use the resources to expand and improve those services, and states must demonstrate that the federal funding "supplements and not supplants" existing funding.
The Iowa Department of Human Services is responsible for administering Iowa's Medicaid program and its home and community-based services within Medicaid. DHS reached out to Iowa stakeholders, including the Iowa Helping Community Policy Group, to provide feedback on the federal opportunity, both in written testimony and through a virtual forum.
Following that feedback, the Department submitted its plan to the federal government for the use of these funds, including:
$80 million for increased training and support
$84 million for expanded access
$57 million for workforce support (including the direct care registry).
The DHS Plan is in the resources section, along with the feedback provided by Charles Bruner on behalf of the Group.
The funding in the American Rescue Plan is time-limited, as all funding provided through that plan is, being a response to COVID-19.
The White House and Congress now are working on longer-term funding to expand the direct care workforce, including but not limited to those providing home and community-based services. This commenced with the Biden-Harris campaign plan to invest $400 billion over the next ten years for direct care workers, including provisions to expand the number of workers, improve their training and career pathways, and raise their compensation.
This White House included this as part of its American Jobs Plan Act, considering this workforce as core to America's infrastructure. The Administration now is pursuing this investment as part of the infrastructure package it is advancing.
A summary of White House and Congressional proposals is in the resources section.