The latest in family caregiving news and policy developments

CAREGIVING POLICY DIGEST

Vol. 27, No. 1 | February 2025

Welcome back to Policy Digest, Family Caregiver Alliance’s newsletter on policy issues impacting family caregivers. A lot has been going on at the federal level, with rapid changes and reverses, so some of this news could change.

Some items to watch include proposed cuts to Medicaid (the biggest payer of Long Term Services and Supports) through the budget reconciliation process and needed reauthorization of Older Americans Act. One celebration includes the passing of the Elizabeth Dole Veteran Caregiver Bill.

POLICY DIGEST:

IN THIS ISSUE

OAA Reauthorization Held at the Desk
The Fight for Medicaid
Elizabeth Dole Veteran Caregiver Bill
Self-Directed Medicaid Services
Consumer Financial Protection Bureau (CFPB) Rule on Medical Debt Inclusion
Medicare Advantage Value-Based Insurance Design (VBID) Model to End
How to Contact Your Representatives

OAA Reauthorization Held at the Desk

The reauthorization of the Older Americans Act (OAA) was initially included in an end-of-year 2024 spending package, making advocates very hopeful that it would be passed in the 118th Congress. The bill, which had passed the Senate, reflected bipartisan negotiations between Senate and House committee leadership. However, at the last minute, it was stripped from this deal because “of political disagreements among Republicans over the size of the omnibus bill” (USAging).

The Older Americans Act funds essential services for older adults and family caregivers (such as respite, training, senior nutrition programs, in-home care, etc.). This version also included reauthorization of the RAISE (Recognize, Assist, Include, Support, Engage) Family Caregivers Act.

The current government budget is a second Continuing Resolution (CR) to extend federal spending and avoid a government shutdown through March 14th, 2025.

Learn more about the status of the OAA and what could be next here.

The Fight for Medicaid

Medicaid, not Medicare, is the primary payer for Long Term Services and Supports, making protection of Medicaid vital for many families to continue to receive LTSS services. As Justice in Aging warns, “Cutting Medicaid Harms Older Adults (and caregivers) No Matter How It’s Sliced.” Cuts to Medicaid, in the form of funding caps or work requirements, are exactly what has been proposed in the Republican led budget reconciliation.

Learn more in this Center for Medicare Rights article.

Elizabeth Dole Veteran Caregiver Bill

One piece of legislation that was successful at passing in the 118th Congress was the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. This bill addresses home care and caregiver programs provided by the Department of Veteran Affairs (VA). The Elizabeth Dole Foundation worked with a coalition of organizations to advance this bipartisan legislation. In their press release they explain that “The Foundation ensured that caregivers and their families were prioritized within the legislation, which includes more than 90 sections addressing such critical issues as long-term care, mental health resources, education, job training, VA modernization and many more. The Elizabeth Dole Home Care Act, a bill within the larger package, will give severely ill and aging veterans the choice to convalesce at home by providing their caregivers increased access to support services.”

Full Bill Text

Self-Directed Medicaid Services

Self-directed Medicaid services are a model where participants, or their representatives, have decision-making authority over certain services and can take direct responsibility managing services. This includes who provides the services and how services are provided. For example, in a self-directed program, a care recipient could choose a family member as their paid caregiver. A new KFF Issue Brief reports that now “All reporting states except Alaska allow Medicaid enrollees to self-direct their home care in at least some circumstances, and among those states all allow enrollees to select, train, and dismiss their caregivers” and “All responding states (which includes the District of Columbia) pay family caregivers under some circumstances and provide family caregivers with other types of support, including respite care.”

Read the full KFF Issue Brief

Consumer Financial Protection Bureau (CFPB) Rule on Medical Debt Inclusion

On January 7, 2025, the Consumer Financial Protection Bureau (CFPB) finalized a rule amending Regulation V, which implements the Fair Credit Reporting Act. The new removes medical debt from credit reports. However, this rule is now on hold, according to Politico, because “a federal judge appointed by Trump ordered the CFPB to pause the rule for 90 days, siding with groups representing credit unions.” If enacted, in addition to excluding medical debt from credit reports used by lenders, the rule prohibits lenders from factoring in medical debt into their lending decisions. According to their press release, “The CFPB’s research   reveals that a medical bill on a person’s credit report is a poor predictor of whether they will repay a loan, and contributes to thousands of denied applications on mortgages that consumers would be able to repay.” If the rule moves forward, it could be news for family caregivers and older adults, who are more likely to have medical debt.

Medicare Advantage Value-Based Insurance Design (VBID) Model to End

The Centers for Medicare & Medicaid Services (CMS) has announced that it will end its Value Based Insurance (VBID) design model under Medicare Advantage plans by the end of calendar year 2025 due to excessive cost. VBID allowed for supplemental caregiver benefits (e.g., respite care, caregiver training), but while the model aimed to incentivize value-driven care, several factors undermined its long-term viability such as failure to align utilization with the highest-value services, no distinction between high and low care needs in what was approved for coverage, challenge showing outcome improvements, and significant upfront costs.

Read the announcement

How to Contact Your Representatives

Call (202) 224-3121 to talk to the offices of your members of Congress. This is the capitol switchboard number, which will take you to a directory.

If you’d like to email your Representative and Senators, you can find your Senators here, and your Representative here.

Credits

Editor: Jenna Shankman

Contributors: Kathleen Kelly, Genevieve D. Caruncho-Simpson

Production: Calvin Hu

Send your feedback or questions to jshankman@caregiver.org or info@caregiver.org.

FCA TWEETS @CaregiverAlly

Follow Family Caregiver Alliance / National Center on Caregiving on X @CaregiverAlly and Executive Director Kathleen Kelly @KKellyFCA.

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