On December 20, the fiscal year 2023 omnibus package was released by Congressional leadership. The 4,000-page $1.7 trillion funding bill, H.R. 2617, includes provisions that address the LeadingAge workforce priorities.  Lawmakers are expected to finalize the bill by December 23, however, the process has been somewhat delayed due to ongoing negotiations, and the possible consideration of amendments.

Some highlights of interest to LeadingAge members pertaining to our aging services workforce priorities include:

• The agreement includes $2 million for the Administration on Community Living (ACL) to implement a direct care workforce demonstration project to identify and reduce barriers to entry for a diverse and high-quality direct care workforce and to explore new strategies for the recruitment, retention, and advancement opportunities needed to attract or retain direct care workers.
  LeadingAge’s recent alert advocated for $10 million for Direct Care Workforce Competitive grants, the amount that was included in the Senate draft Labor-HHS FY 2023 appropriations bill, and enacting the Direct CARE Opportunity Act (S. 2344, H.R. 2999), that would provide competitive grants for recruitment and staffing wage subsidies. Additionally, LeadingAge supported $20 million being allocated for ACL’s creation of a Direct Care Workforce Technical Assistance Center.
• The agreement provides $285 million for the Registered Apprenticeship Program, an increase of $50 million above the FY 2022 funding level. LeadingAge had urged funding of $303 million for the Registered Apprenticeship Program, as noted in our recent alert.

The accompanying report language for the Apprenticeship Program urges the Department of Labor’s (DOL) Employment and Training Administration (ETA), in collaboration with the Department of Health and Human Services (HHS), to support the expansion of the skilled care workforce to care for a rapidly aging U.S. population and provide home and community-based services to older adults and people with disabilities, including through education and training grant programs, as well as traditional and nontraditional apprenticeship programs.

• The agreement’s report language supports the Health Resources Services Administration’s (HRSA) efforts to “develop the workforce needed to care for a rapidly aging U.S. population” and encourages the agency to address the skilled care workforce needs of seniors through existing workforce education and training programs. No targeted funding has been allocated for this purpose.
• The agreement allocates $14 million to HRSA for Behavioral Health Workforce Education and Training programs. LeadingAge had supported the $30 million increase that was allocated to support and prevent burnout and behavioral health conditions among healthcare providers, as included in the draft Senate Labor-HHS Appropriations bill.
• The omnibus bill allocates an additional $2 million above the FY 2022 level for HRSA’s Geriatrics Workforce Enhancement Program (GWEP) supports training to integrate geriatrics into primary care delivery and develops academic primary care-community-based partnerships to address gaps in health care for older adults.

Congress did not take action on the following LeadingAge FY 2023 aging services workforce appropriation priorities:

• Funding for the National Health Care Workforce Commission authorized by the Affordable Care Act.
• Funding to HHS to support staffing wage subsidies that deliver tuition, childcare and transportation assistance.
• A CMS study of on-site nursing staff coverage with $50 million, as specified in the Nursing Home Workforce Training Grants.
• Increasing our pipeline of prospective workers by funding the Department of HHS and Education to jointly develop and implement an aging services training program for high school students.
• Reauthorize and expand grants that train low-income workers for high-demand jobs by supporting the Health Profession Opportunity Grants program with $40 million.
• Direct the Biden Administration to establish an Interagency Aging Services Workforce Taskforce and report on activities to Congress.

Foreign Workforce Requests Left Out. Thus far, the omnibus appropriations agreement left out a bipartisan “DACA/Border” negotiated proposal from Sens. Kyrsten Sinema (I-AZ) and Thom Tillis (R-NC), that would have given many of the 11 million undocumented people living in the U.S. a pathway to legal status and implement new investments in a more secure border.

Also absent are several of the foreign workforce immigration policies, as highlighted in the November 28, LeadingAge letter urging Congress to support proposals that would help ensure aging services providers can meet the needs of older adults who are in need of services. The letter, and recent alerts, asked Congress to include in the final year-end legislative package:

• Citizenship for Essential Workers Act (S. 747, H.R. 1909), which would create a pathway to citizenship and permanent residency status for aging service workers deemed “essential” during the COVID-19 public health emergency.
• Health Care Workforce Resilience Act (S. 1024/H.R. 2255), which would recapture unused employment-based immigrant visas and make them available to 40,000 foreign nurses and doctors.
• The Workforce for an Expanding Economy Act (H.R. 4288) and the Essential Workers for Economic Advancement Act (H.R. 7239), would create a new visa system and allow employers to legally hire non-agricultural temporary less-skilled workers on a year-round process.

The agreement includes report language that directs the U.S. Department of State’s Consular Operations to submit a report to the Committees on Appropriations detailing steps taken to address visa (and passport) processing backlogs, including expansion of interview waivers, implementation of new technology, and increases for staffing, and submit a report to Congress no later than 90 days after the enactment of the Act. These efforts should assist with the timely processing of visas for foreign-trained workers, which LeadingAge has written to the State Department, along with various stakeholders, as we seek ways to expedite the processing backlog, especially for nurses who could be employed by LeadingAge communities.

Overall, LeadingAge is pleased Congress has included several of our aging services workforce priorities in the omnibus appropriations bill. We will continue to raise awareness regarding the importance of taking action to address this crisis during the upcoming 118th session of Congress.