On Jan. 26, 2023, Sen. Bob Casey of Pennsylvania and Rep. Debbie Dingell of Michigan reintroduced the Better Care Better Jobs Act, a bill to permanently raise the federal Medicaid match for home and community-based services by 10 percentage points in states that qualify, according to the sponsors' release.
What the bill proposed
To get the higher match, states would have to expand access to services and strengthen the workforce. The release said states would need to update payment rates regularly, and that those updates should raise wages for direct care workers.
The sponsors cited more than 650,000 people on waiting lists for home and community-based care. They also said the median home care wage was about $13 an hour, that roughly 18% of these workers lived in poverty, and that turnover was estimated at over 60%.
Why this mattered for providers and DSPs
For provider agencies serving people with intellectual and developmental disabilities, the bill tied new federal money to rate updates meant to reach frontline paychecks. That link between Medicaid rates and wages ran through much of the federal debate in 2023 and 2024. In October 2023, Casey also introduced a shorter-term bill, the HCBS Relief Act, to extend emergency funding for the workforce.