A $150 billion increase in Medicaid home and community-based services (HCBS) funding, an expansion of paid family medical leave, and much-needed in funding for the U.S. Administration for Community Living (ACL) are among the details in the Biden administration's fiscal year 2024 budget request released on March 9 (download the current funding table). 

If approved, the budget proposal would make an estimated 2 million additional adults eligible for health insurance coverage in states that have opted not to expand Medicaid under the Affordable Care Act. Among the Medicare improvements are continued reductions in Medicare prescription drug costs  and an extension of the Medicare Part A Trust Fund solvency by an estimated 25 years.

"Let’s be clear about another key point of my budget. I guarantee you I will protect Social Security and Medicare without any change," Biden said during a news conference unveiling his budget proposal. "It will secure Medicare through 2050 and beyond, ensuring that the vital program keeps going strong for a generation without cutting a single penny in benefits."

The budget request addresses what Acting ACL Administrator Alison Barkoff said are "two urgent priorities: strengthening and supporting the caregiving infrastructure and preventing abuse and neglect." 

Below are the proposals in the budget plan NCOA is tracking.

Medicare

• Extend Medicare Part A Trust Fund solvency by an estimated 25 years.
• Include Medicare prescription drug provisions to increase the number of drugs subject to negotiation, make drugs eligible for negotiation more quickly, and require plans to offer a list of generic drugs with a maximum copayment of $2 for a 30-day supply.
• Expand access to Medicare Savings Programs (MSPs) by aligning eligibility processes with the Part D Low-Income Subsidy (LIS) to reduce administrative barriers to enrollment.
• Expand and enhance access to Medicare coverage of nutrition and obesity counseling.
• Establish a demonstration to test Medicare coverage of medically tailored meals for beneficiaries with a diet-impacted disease.
• Expand the current Medicare Diabetes Prevention Program model to be a permanent benefit.
• Require Medicare to cover up to three behavioral health visits per year without cost-sharing when furnished by participating providers.
• Provide coverage of select, evidence-based support services delivered by community health workers for prevention and care navigation for chronic or behavioral health conditions, in addition to screening for social determinants of health.

Medicaid

• Invest $150 billion over 10 years to improve access to Medicaid HCBS, which would reduce waiting lists and allow older adults and people with disabilities to remain in their homes, as well as helping to address the growing direct care workforce crisis.
• Provide Medicaid-like coverage to individuals in states that have not adopted Medicaid expansion under the ACA, with financial incentives to ensure that states maintain existing expansions. U.S. Health and Human Services (HHS) Secretary Xavier Becerra said that would amount to coverage for an additional 2 million people.

Caregiving/Workforce/Mental Health

• Establish a national comprehensive paid family and medical leave program, providing up to 12 weeks of leave to allow eligible workers to take time off, including for care of a seriously ill loved one.
• Improve the "customer experience" for Americans through such improvements as simplifying the process to apply for Supplemental Security Income, additional funding for the Department of State to "revamp the delivery of Passport Services so the public can access core services online," and streamlining passenger screening at some airports.
• Allocate an additional $4 billion to the Substance Abuse and Mental Health Services Administration to "meet behavioral health needs, including funds to increase access to crisis services and grow the behavioral health workforce, as well as address substance use disorders, which is killing far too many of our family members," Becerra said.

Aging Services

The request proposes an historic $3 billion budget for the ACL. It reflects the new realities from the pandemic, including increased demand for services, a continued preference for in-home versus congregate services, and the ongoing struggle to secure an adequate paid and volunteer workforce.

Notable Older Americans Act (OAA) increases:

• Supportive services and senior centers: $90 million
• Nutrition services: $217.6 million
• Falls prevention competitive grants: $2.5 million
• Native American Nutrition & Supportive Services: $32 million
• Family Caregiver Support Services: $45 million
• Elder Justice/Adult Protective Services: $43 million
• Aging Network Support: $9.5 million (including $8 million for Direct Care Workforce Demonstration)
• Lifespan Respite Care: $4.2 million

The budget request also calls for a five-year extension of the Medicare Improvements for Patients and Providers Act (MIPPA) to continue efforts to provide outreach and assistance to low-income Medicare beneficiaries with continued funding of the Research, Demonstration, and Evaluation Center at the current levels secured.

Agriculture Secretary Tom Vilsack praised the president's budget proposal for including provisions to "protect and strengthen Medicare and Social Security" but also for important investments in nutrition programs. 

Additionally, the budget continues the longstanding bipartisan commitment to fully fund the SNAP and WIC programs to serve all projected participants and ensure access to USDA’s far-reaching, powerful tools."

 

Learn more about proposed investments in aging services at the Departments of Labor, Housing and Urban Development, and Agriculture, and the Corporation for National Service in our annual funding table.

What’s next for Biden's FY24 budget request?

The release of the budget request kicks off the annual appropriations process, and NCOA is already collaborating with several of our Congressional champions to advocate for increases in aging services, at levels significantly exceeding the administration’s request. These include increases for the Medicare State Health Insurance Assistance Program (SHIP) and the Senior Community Service Employment Program (SCSEP), which are level-funded in the administration’s request.

Stay tuned for fact sheets for ways you can help NCOA advocate for this crucial funding for the aging services networks and the older adults and caregivers it serves. This debate is expected to continue throughout the year.

We also expect House Republican leaders to release their budget priorities sometime this spring.  Although they have pledged not to cut Medicare and Social Security, some members are advocating for significant cuts in Medicaid, the Supplemental Nutrition Assistance Program (SNAP), and non-defense discretionary programs. Throughout these federal budget discussions, NCOA will continue to advocate for our key policy issues toward our vision of a just and caring society in which each of us, as we age, lives with dignity, purpose, and security.