Biden’s Plan Addresses Key Caregiver Concerns


President-elect Joe Biden is the first major party nominee in recent memory to put caregiver issues front and center in his Presidential campaign. During a policy address on July 21, he rolled out a plan to address several key long-standing concerns of Well Spouses and all caregivers and care recipients.  The features of Biden’s plan include:

  • Up to 12 weeks of paid family and medical leave
  • An end to the bias in Medicaid-funded long-term care which has long favored nursing home care over home care—including an end to waiting lists for home care, and increased Federal funding for home care
  • Recognizing the contribution of unpaid family caregivers by providing them with Social Security credits as well as tax credits of up to $5,000
  • An Innovation Fund to expand home-based alternatives to institutional care, such as home modification assistance
  • Increase the pay, benefits, training opportunities and collective bargaining rights for paid professional care workers
  • The revenues needed to pay for the plan would be raised by closing a tax loophole benefitting certain taxpayers with incomes above $400,000 per year, and closer IRS scrutiny of returns filed by high income taxpayers

For many Well Spouses, ending Medicaid’s current bias in favor of nursing home care is especially important. In contrast to nursing home care, which is effectively an entitlement for those who meet Medicaid’s stringent medical and financial eligibility rules, today there is no entitlement to long-term care at home. Access and coverage (for example, maximum hours per week of paid caregiver coverage) vary widely from state to state, depending on funding and state law. As a result, about 800,000 people nationwide who meet Medicaid eligibility requirements are on waiting lists for Medicaid-funded home care. Some of them have been waiting for as long as five years. Biden’s plan would end these waiting lists and eliminate Medicaid’s long-standing discrepancy in access to long-term care at home vs. in an institution.

Long-term care (whether at home or in a nursing home) would continue to be delivered via Medicaid under Biden's plan, which means people would still need to drain their financial resources before they could gain access to coverage. Rep. Jayapal's (D-WA) Medicare for All bill, by contrast, would make long-term care a universal non-means tested benefit.

Nor would the Biden plan end state rules that prohibit the use of Medicaid funds to compensate spousal caregivers, or provide them with respite. But for Well Spouses, the Biden plan represents welcome progress and an important beginning.

For a more complete description of Biden’s caregiving plan, see .