President Joe Biden signed Executive Order 14095, "Increasing Access to High-Quality Care and Supporting Caregivers," on April 18, 2023, directing federal agencies to act on Medicaid home care access and care worker pay, according to the order as published in the Federal Register. Disability Scoop reported that the order set in motion more than 50 actions across agencies.
What the order asked for
Several sections touched Medicaid home and community-based services:
- The Centers for Medicare & Medicaid Services (CMS) was told to issue guidance to states on using enhanced funding to better connect HCBS workers with the Medicaid beneficiaries they serve.
- The Department of Health and Human Services was told to consider rulemaking to improve access to HCBS, including steps to support provider participation.
- The Labor Department was told to analyze how home care workers' pay compares with that of workers with similar training and skill.
Why this mattered for providers and DSPs
An executive order does not change rates or wages on its own, but this one pointed federal agencies toward the workforce that DSPs are part of. About two weeks later, CMS released its proposed Medicaid access rule, which included a plan to require that most home care payments go to worker compensation. In December 2023, CMS issued guidance on worker registries that the White House called a key deliverable from the order.