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The Kaiser Family Foundation (KFF) is a nonprofit foundation dedicated to national and global health policy and news. KFF recently hosted several focus groups consisting of both paid and nonpaid HCBS caregivers. HCBS caregiver concerns varied some; however, chief among the concerns was low wages. Can Biden’s American Jobs Plan help? In this post, Direct Care Innovations discusses more about the issue.

How Biden's Budget Addresses HCBS Caregiver Concerns

The Focus Groups

Focus group participants included home health aides, certified nursing assistants, direct service professionals, and personal care attendants. Some were paid workers while others weren’t. Some work part-time while others work full-time, and most participants have worked in the industry between 1-5 years. Group participants shared HCBS caregiver concerns on vaccinations, staffing shortages, job demands, and low wages.

Job Demands and Expectations

HCBS caregivers relayed both physical and mental challenges on the job. For instance, they discussed physical demands, including lifting and transporting clients and assisting with bathing and toileting. In addition, caregivers described pandemic-induced stress and challenging clients. Overall, participants agreed that both physical and mental stressors exist in the role.


The KFF report states that the majority of its participants were vaccinated, but it doesn’t clarify whether that number is 51%, 99%, or somewhere in between. HCBS caregiver concerns among the vaccinated included their unvaccinated peers. On the other hand, the vaccine-hesitant expressed concerns about employer mandates.

Staffing Shortages

Speaking of mandates, it remains unclear as to whether and how much vaccine mandates impact ongoing staffing shortages. Some individuals were vocal about their refusal to become vaccinated. In other words, some people feel strongly enough to leave their jobs over the issue. Others shared concerns about being asked to stay late or work additional shifts because of staffing shortages. At the same time, others believe that low wages play an important role in staffing shortages.

Low Wages

Across the board, HCBS caregivers shared concerns about their wages. The groups shared a nearly universal belief that they were underpaid. Most participants receive pay through Medicare. Consequently, many reported not having received raises. Those who received raises reported small increases that don’t compensate for the cost of living increases. 

How does the budget reconciliation package address this?

Budget Reconciliation

President Biden allotted $400 billion toward HCBS caregivers services and administration. If you work in the Medicaid industry, then you understand that’s a historic amount. However, the current bill in the U.S. House sits closer to $190 billion. What does that get? 

First, it provides raises to HCBS caregivers. Second, it provides funds to Medicaid Agencies to develop professional training, provide respite care, and numerous other initiatives. Third, it provides more autonomy for self-directed care. Next, it supports recruitment and retention efforts. Providers must meet certain criteria to receive funding.

About DCI

Direct Care Innovations serves clients in all 50 U.S. states. Our business management software meets EVV requirements while also streamlining your workflow and making administration easier. Schedule a free demo or call us at (480) 295-3307 to learn more. 


Voices of Paid and Family Caregivers for Medicaid Enrollees Receiving HCBS

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