Increasing Access to High-Quality Care and Supporting Caregivers
Executive Order 14095, titled Increasing Access to High-Quality Care and Supporting Caregivers, was signed by President Biden on April 18, 2023. The order directs federal agencies to use their existing authorities to boost the supply, affordability, and quality of child care and long-term care (for older adults and people with disabilities), strengthen the care workforce (including better pay, benefits, and working conditions), and provide greater support for family caregivers. It also emphasizes expanding training and career pathways, improving data on the care workforce, expanding care options for veterans, and increasing coordination with Tribes and rural communities. While the order sets policy goals and directions, it does not by itself authorize new funding; many actions rely on guidance, guidance-based requirements, pilot programs, or better use of existing federal funds. The overarching aim is to reduce barriers to affordable, high-quality care, stabilize and grow the care workforce, and empower families and caregivers. If implemented effectively, the order could improve access to care for working families, advance equity in the care workforce, and expand care options for service members, veterans, and rural/Tribal communities. Actual impact will depend on subsequent agency rules, guidance, funding levels, and state implementation.
Key Points
- 1Elevate compensation and improve job quality for the care workforce: directs agencies to issue guidance to connect home- and community-based workers with Medicaid funding opportunities, align compensation with teachers where feasible, improve access to health insurance, enhance CCAMPIS-based supports for early educators, promote retirement savings availability, and address burnout and mental health needs; includes steps to increase staffing transparency in nursing homes and reduce staff turnover.
- 2Expand training, professional development, and data-driven planning: directs Labor, Education, and HHS to create and promote training pathways (including community college programs, apprenticeships, and other credentials); offer innovative funding and demonstration projects to raise job quality; build partnerships with states, tribes, unions, higher education, and disability networks; and fund a government-wide data review to fill gaps about the home- and community-based care workforce, with findings due publicly by April 2024.
- 3Strengthen support for family caregivers and improve care access/affordability: includes testing new dementia-focused care payment and delivery models; improve caregiver involvement in hospital discharge planning; expand caregiver access to Medicare information; consider VA caregiver program enhancements (including a rulemaking consideration and a telehealth pilot for caregiver mental health); and expand AmeriCorps programs to attract more people into early learning careers and prioritize high-quality programs.
- 4Expand care supply and reduce costs for families: identify how to use agency discretionary and program funds (including infrastructure, CHIPS-era provisions, and CCDF/Head Start-related funds) to support workers with affordable care services on federally funded projects; push for actions to lower child care costs, increase Head Start/CCDF eligibility, promote TANF-linked supports, and improve access to care for federal employees; include DoD efforts to improve child care affordability and recruitment.
- 5Build capacity, include veterans and rural/Tribal communities, and encourage private financing: promote Veteran Directed Care expansion and a multistate/ multi-site Co-Employer option for veteran home health; urge strengthening of tribal CCDF/Head Start use and reducing administrative barriers; encourage private financing pathways (CDFIs, SBA guidance for care businesses, and CFPB guidance to shield workers from excessive financial burdens); support Rural Partners Network efforts to expand care access in rural areas; and foster broad cross-agency coordination with stakeholders (families, workers, unions, care providers).