To a US Senator: support the Better Care Better Jobs Act

Personalize. If you, a family member, or someone you provide care for is on a waiting list — or has been on one — name that experience. If you’re a direct-care worker, your perspective is especially valuable. The political coalition for HCBS expansion has been growing; constituent letters add to the pressure.

Dear Senator [Last Name],

I’m writing as a constituent in [city/town] to ask you to support the Better Care Better Jobs Act and to advance substantial federal Home and Community-Based Services funding in the next legislative vehicle that comes available.

More than 700,000 disabled Americans are on Medicaid HCBS waiting lists across 38 states. Many wait five to ten years or more. The federal-right-to-services architecture established by Olmstead v. L.C. (1999) functions, in practice, as a federal-right-to-be-on-a-list.

The structural cause is the Medicaid funding architecture. Coverage of nursing-home care is mandatory under federal law; HCBS coverage is largely optional under federal waivers. State budgets respond to the structural bias toward institutional care, and the result is the waiting list crisis we now have.

The Better Care Better Jobs Act would address the structural pattern through several mechanisms:

1. Substantial federal HCBS funding with conditions on state implementation, addressing the waiting-list crisis directly.

2. Direct-care worker wage standards conditioned on the funding. The workforce shortage that constrains HCBS access is directly tied to wages well below livable-wage thresholds in many states; federal wage floors would address it.

3. Mandatory state HCBS plans with waiting-list reduction targets and accountability measures.

4. Expanded supported-employment funding for disabled workers in competitive integrated employment.

5. Money Follows the Person reauthorization at expanded scale, supporting transitions from institutional to community settings.

[Personalize: name a specific concern. Examples: “My family member has been on the [state] HCBS waiting list for [period]”; “I’m a parent of a person with disabilities trying to find adequate community-based services”; “I’m a direct-care worker earning [wage] and watching colleagues leave the field”; “Our [community/family] depends on services that have been chronically underfunded”.]

The Build Back Better framework included substantial HCBS investment that did not survive the Senate negotiations producing the Inflation Reduction Act. Reintroducing the framework in the next major vehicle is the operative legislative priority.

The political coalition for HCBS expansion has been growing — disability-rights organizations, senior advocacy groups, family-caregiver coalitions, and direct-care worker unions all support meaningful federal action. The aging of the baby boomer population is producing rapid demand growth that the current system cannot absorb.

I’d appreciate knowing your position on the Better Care Better Jobs Act and on HCBS funding in the next major legislative vehicle.

Thank you for your service.

Sincerely,

[Your name] [Your address]