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President Biden and Secretary Becerra Discuss Medicaid Access Rule

April 12, 2024

Recent comments from leaders within the Executive Branch foreshadow a required passthrough within the Medicaid Access Final rule, which will likely be released before the end of April. On Tuesday, April 9th, President Joe Biden addressed a gathering of advocates focused on the “care economy,” a term used to encompass the childcare and long-term care workforces. As part of his remarks, the President promised, “in the coming weeks, we plan to release new rules to strengthen staffing standards in nursing homes, to get homecare workers a bigger share of Medicaid payments.”

On Thursday, April 11th, Secretary Becerra provided additional details on the Medicaid Access Rule, telling a separate group of advocates for care economy workers that the Administration would advance a rule, “that lift the wages of homecare workers, because what it will do, it will say every time we make a payment to whoever is getting the money to do the service, 80% of it has to go to the worker. 80%. No more of this, ‘well, we have a high overhead,’ or we had to increase our executive wage. No, 80% of dollars paid out must be focused on the workers.”

The remarks from these leaders refer to the Medicaid Access Rule, which was initially proposed in May 2023 and contains a provision that would mandate 80% of all Medicaid payments for homemaker, home health aide, and personal care services be paid as compensation to direct care workers. While well intentioned, the rule does not account for the various regulatory and statutory requirements associated with delivering these services, such as nurse supervision, electronic visit verification, travel mileage reimbursement, or other necessary expenses. Additionally, the rule would place a significant burden of monitoring and enforcing the requirements on state governments. For these reasons, States from all political leanings expressed significant concerns with the provision.

The Medicaid Access Rule is currently at the Office of Management and Budget for review, which is the final clearance step before rules are released. The Final Rule is expected before the end of April.

Becerra Remarks:

Biden Transcript:

NAHC Medicaid Access Rule Link: