I 

111TH CONGRESS 

1ST SESSION H. R. 4224 

To establish a pilot program to train public housing residents as home 

health aides and in home-based health services to enable such residents 

to provide covered home-based health services to residents of public 

housing and residents of federally-assisted rental housing, who are elderly 

and disabled, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

DECEMBER 8, 2009 

Ms. VELA ́ZQUEZ (for herself, Mr. FRANK of Massachusetts, and Ms. WATERS) 

introduced the following bill; which was referred to the Committee on Financial Services 

A BILL 

To establish a pilot program to train public housing residents 

as home health aides and in home-based health services 

to enable such residents to provide covered home-based 

health services to residents of public housing and residents of federally-assisted rental housing, who are elderly 

and disabled, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Together We Care Act 

5 of 2009’’. 


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1 SEC. 2. FINDINGS AND PURPOSE. 

2 (a) FINDINGS.—The Congress finds the following: 

3 (1) The ‘‘baby boom’’ generation will require 

4 health care attention that will exceed the current 

5 supply of health care providers. 

6 (2) There is a shortage of training programs 

7 specializing in health care and long-term services 

8 that focus on home care instead of institutionalized 

9 care. 

10 (3) Although the need for home-based health 

11 services transcends all income levels, the availability 

12 of such services is more limited for residents of pub13 lic housing. 

14 (4) Estimates indicate that there are 

15 44,000,000 caregivers in the United States pro16 viding unpaid care to at least one adult, representing 

17 22,900,000 households. 

18 (5) Of working persons providing unpaid care, 

19 62 percent have had to make adjustments to work 

20 schedules or leave employment. 

21 (6) Many low-income families in the United 

22 States are placed in an untenable position of choos23 ing between work and caregiving responsibilities at 

24 home. 

25 (7) Many residents of public housing in the 

26 United States are aging and in need of care. 


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1 (8) The Department of Housing and Urban De2 velopment estimates the percentage of households 

3 assisted by the Department that are elderly house4 holds is 35 percent in New York, 33 percent in Bos5 ton, 35 percent in Chicago, 24 percent in Cleveland, 

6 40 percent in Los Angeles, and 20 percent in Puerto 

7 Rico. 

8 (9) New service programs are needed to provide 

9 home-based health services to residents of public 

10 housing and to provide job training and job place11 ment for persons receiving assistance from the De12 partment of Housing and Urban Development need13 ing employment. 

14 (10) The Department of Housing and Urban 

15 Development should establish a home-based health 

16 services pilot program to meet the challenges of the 

17 increasing number of elderly persons and persons 

18 with disabilities in public housing, which would si19 multaneously create an opportunity to train job 

20 seekers in a trade that provides home-based health 

21 services. 

22 (b) PURPOSES.—The purposes of this Act are— 

23 (1) to give flexibility to the Department of 

24 Housing and Urban Development and other entities 


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1 to establish training programs in home-based health 

2 services for public housing residents; and 

3 (2) to provide needed home care options to el4 derly and disabled public housing residents (includ5 ing elderly and disabled veterans who are public 

6 housing residents) and elderly and disabled residents 

7 of federally-assisted rental housing to allow them to 

8 remain in their homes and their communities. 

9 SEC. 3. PILOT GRANT PROGRAM TO TRAIN PUBLIC HOUS10 ING RESIDENTS TO PROVIDE COVERED 

11 HOME-BASED HEALTH SERVICES. 

12 Section 34 of the United States Housing Act of 1937 

13 (42 U.S.C. 1437z–6) is amended by adding at the end 

14 the following new subsections: 

15 ‘‘(f) PILOT GRANT PROGRAM TO TRAIN PUBLIC

16 HOUSING RESIDENTS TO PROVIDE COVERED HOME17 BASED HEALTH SERVICES.— 

18 ‘‘(1) ESTABLISHMENT OF PILOT GRANT PRO19 GRAM.—The Secretary, in consultation with the Sec20 retary of Health and Human Services, shall estab21 lish a competitive grant program to make grants to 

22 eligible entities under paragraph (2) for use for the 

23 training of public housing residents as home health 

24 aides and as providers of home-based health services 

25 (including as personal and home care aides) to enVerDate Nov 24 2008 06:09 Dec 09, 2009 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4224.IH H4224

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1 able such residents to provide covered home-based 

2 health services to— 

3 ‘‘(A) residents of public housing who are 

4 elderly or disabled, or both (including elderly 

5 and disabled veterans who are residents of pub6 lic housing); and 

7 ‘‘(B) subject to the criteria set forth pur8 suant to paragraph (3), residents of federally9 assisted rental housing who are elderly or dis10 abled, or both. 

11 ‘‘(2) ELIGIBLE ENTITIES.—A grant under this 

12 subsection may be made only to an entity that— 

13 ‘‘(A) is a public housing agency or other 

14 unit of State or local government (including an 

15 agency of such unit), community health center, 

16 home care provider organization, faith-based or17 ganization, labor organization, or other organi18 zation determined to be qualified by the Sec19 retary; and 

20 ‘‘(B) demonstrates to the satisfaction of 

21 the Secretary that it has established, or pro22 vides such assurances that it will establish, an 

23 employment training program to train public 

24 housing residents to provide covered homeVerDate Nov 24 2008 06:09 Dec 09, 2009 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4224.IH H4224

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1 based health services that complies with regula2 tions that the Secretary shall issue. 

3 ‘‘(3) RESIDENTS OF FEDERALLY-ASSISTED

4 RENTAL HOUSING.—The Secretary may set forth 

5 criteria under which an entity receiving funding 

6 under this subsection may train public housing resi7 dents to provide covered home-based health services 

8 to elderly and disabled residents of federally-assisted 

9 rental housing. 

10 ‘‘(4) APPLICATION.—To be eligible for a grant 

11 under this subsection an eligible entity under para12 graph (2) shall submit to the Secretary an applica13 tion at such time, in such manner, and containing 

14 such information as the Secretary shall require. 

15 ‘‘(5) COMPETITIVE GRANT AWARDS.— 

16 ‘‘(A) GENERAL CRITERIA FOR SELEC17 TION.—The Secretary shall establish policies 

18 and procedures for reviewing and approving 

19 funding for eligible entities through a competi20 tive process taking into consideration— 

21 ‘‘(i) with respect to the service area in 

22 which public housing residents trained 

23 under an employment training program de24 scribed in paragraph (2)(B) will provide 

25 covered home-based health services— 


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1 ‘‘(I) the percentage of residents 

2 age 62 and older; 

3 ‘‘(II) the percentage of disabled 

4 residents; and 

5 ‘‘(III) the percentage of unem6 ployed or underemployed residents; 

7 ‘‘(ii) the ability of an eligible entity to 

8 provide training that leads to the provision 

9 of quality care; 

10 ‘‘(iii) the record of the quality of care 

11 of an eligible entity; and 

12 ‘‘(iv) such other criteria as determined 

13 by the Secretary. 

14 ‘‘(B) GEOGRAPHIC CONSIDERATION.—In 

15 awarding grants, the Secretary shall consider a 

16 geographic mix of a variety of eligible entities 

17 so that the grant program will include at 

18 least— 

19 ‘‘(i) one employment training program 

20 described in paragraph (2)(B) that pri21 marily serves an urban population; 

22 ‘‘(ii) one employment training pro23 gram described in paragraph (2)(B) that 

24 primarily serves a rural population; 


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1 ‘‘(iii) one employment training pro2 gram described in paragraph (2)(B) that 

3 primarily serves an Indian population; and 

4 ‘‘(iv) one employment training pro5 gram described in paragraph (2)(B) that 

6 primarily serves a population in the Com7 monwealth of Puerto Rico, the United 

8 States Virgin Islands, Guam, American 

9 Samoa, or the Commonwealth of the 

10 Northern Mariana Islands. 

11 ‘‘(6) USE OF GRANT FUNDS.—An entity receiv12 ing funding under this subsection may use such 

13 funds— 

14 ‘‘(A) to establish (or maintain) and carry15 out an employment training program to train 

16 public housing residents to provide covered 

17 home-based health care services to elderly and 

18 disabled public housing residents and elderly 

19 and disabled residents of federally-assisted rent20 al housing; 

21 ‘‘(B) for the transportation expenses of 

22 public housing residents in training under such 

23 an employment training program; 


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1 ‘‘(C) for the child care expenses of public 

2 housing residents in training under such an em3 ployment training program; 

4 ‘‘(D) for the administrative expenses of 

5 carrying out such an employment training pro6 gram; and 

7 ‘‘(E) for any other activity the Secretary 

8 determines appropriate. 

9 ‘‘(7) REPORT TO CONGRESS.—Not later than 

10 24 months after the date of the enactment of the 

11 Together We Care Act of 2009, the Secretary shall 

12 submit to Congress a report on the use and impact 

13 of the grant program established by this subsection. 

14 The report shall include— 

15 ‘‘(A) a review of the effectiveness of the 

16 program in— 

17 ‘‘(i) providing jobs for public housing 

18 residents; 

19 ‘‘(ii) meeting the unmet health and 

20 long-term care needs of elderly and dis21 abled residents of public housing and elder22 ly and disabled residents of federally-as23 sisted rental housing; and 

24 ‘‘(iii) enabling the provision of quality 

25 care; and 


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1 ‘‘(B) any recommendations the Secretary 

2 determines appropriate regarding the grant pro3 gram. 

4 ‘‘(8) DEFINITIONS.—As used in this subsection, 

5 subsection (g), and subsection (h): 

6 ‘‘(A) HOME-BASED HEALTH SERVICES.— 

7 The term ‘home-based health services’ means 

8 health care and long-term services provided to 

9 an individual in a place of residence used as 

10 such individual’s home and includes— 

11 ‘‘(i) home health services described in 

12 section 1861(m) of the Social Security Act 

13 (42 U.S.C. 1395x(m)); 

14 ‘‘(ii) personal care services described 

15 in section 1905(a)(24) of such Act (42 

16 U.S.C. 1396d(a)(24)); and 

17 ‘‘(iii) home-based services which may 

18 be covered under a waiver under subsection 

19 (c) or (d) of section 1915 of such Act (42 

20 U.S.C. 1396n). 

21 ‘‘(B) HOME HEALTH AIDE.—The term 

22 ‘home health aide’ has the meaning given the 

23 term in section 1891(a)(3)(E) of the Social Se24 curity Act (42 U.S.C. 1395bbb(a)(3)(E)). 


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1 ‘‘(C) COVERED.—The term ‘covered’ 

2 means, with respect to home-based health serv3 ices, such services— 

4 ‘‘(i) for which medical assistance is 

5 available under a State plan under title 

6 XIX of the Social Security Act; or 

7 ‘‘(ii) for which financial assistance is 

8 available under subsection (g). 

9 ‘‘(D) FEDERALLY-ASSISTED RENTAL

10 HOUSING.—The term ‘federally-assisted rental 

11 housing’ means— 

12 ‘‘(i) housing assisted under section 

13 202 of the Housing Act of 1959 (12 

14 U.S.C. 1701q); 

15 ‘‘(ii) housing assisted under section 

16 515 of the Housing Act of 1949 (42 

17 U.S.C. 1485); 

18 ‘‘(iii) housing assisted under section 8 

19 of the United States Housing Act of 1937 

20 (42 U.S.C. 1437f) (including project-based 

21 and tenant-based assistance); 

22 ‘‘(iv) housing assisted under the block 

23 grant program under the Native American 

24 Housing Assistance and Self-Determina25 tion Act of 1996 (25 U.S.C. 4101 et seq.); 


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1 ‘‘(v) housing financed by a mortgage 

2 insured under section 221(d)(3) of the Na3 tional Housing Act (12 U.S.C. 

4 1715l(d)(3)) or held by the Secretary, a 

5 State, or State agency; and 

6 ‘‘(vi) housing assisted under section 

7 811 of the Cranston-Gonzalez National Af8 fordable Housing Act (42 U.S.C. 8013). 

9 ‘‘(9) INAPPLICABILITY OF PREVIOUS SUB10 SECTIONS.—Subsections (a) through (e) shall not 

11 apply to this subsection, subsection (g), and sub12 section (h). 

13 ‘‘(10) RULE OF CONSTRUCTION.—This sub14 section and subsection (g) may not be construed as 

15 affecting any requirement under State law for train16 ing, licensure, or any other certification as a home 

17 health aide or as a provider of any home-based 

18 health service under this subsection and subsection 

19 (g). 

20 ‘‘(11) REGULATIONS.—Not later than 6 months 

21 after the date of enactment of the Together We Care 

22 Act of 2009, the Secretary shall issue regulations to 

23 carry out this subsection. 

24 ‘‘(12) AUTHORIZATION OF APPROPRIATIONS.— 

25 There are authorized to be appropriated $2,500,000 


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1 for each of the fiscal years 2010, 2011, and 2012, 

2 for grants under this subsection. 

3 ‘‘(g) FINANCIAL ASSISTANCE FOR HOME-BASED

4 HEALTH SERVICES IN CERTAIN JURISDICTIONS.— 

5 ‘‘(1) FINANCIAL ASSISTANCE.—The Secretary, 

6 in consultation with the Secretary of Health and 

7 Human Services, may provide financial assistance 

8 under this subsection to entities receiving grant 

9 funds under the pilot program established under 

10 subsection (f) that provide training for public hous11 ing residents as home health aides and as providers 

12 of home-based health services and provide (or pay 

13 for) such services for use only for their costs in pro14 viding (or paying for) such services to— 

15 ‘‘(A) residents of public housing who are 

16 elderly or disabled, or both (including elderly or 

17 disabled veterans who are residents of public 

18 housing); or 

19 ‘‘(B) at the discretion of the Secretary, 

20 residents of federally-assisted rental housing 

21 who are elderly or disabled, or both. 

22 ‘‘(2) REQUIREMENTS.— 

23 ‘‘(A) LOCATION.—Assistance under para24 graph (1) may be provided only for services fur25 nished in locations in which medical assistance 


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1 for home-based health services is not available 

2 under a State plan under title XIX of the So3 cial Security Act. 

4 ‘‘(B) TRAINED PUBLIC HOUSING RESI5 DENTS.—Assistance under paragraph (1) may 

6 be used only for costs of services described in 

7 paragraph (1) that are provided by public hous8 ing residents trained by an entity receiving 

9 grant funds under the pilot program established 

10 under subsection (f). 

11 ‘‘(3) ELIGIBILITY.—To be eligible for financial 

12 assistance under this subsection an entity shall— 

13 ‘‘(A) provide such assurances as the Sec14 retary shall require that it will use the funds 

15 only as provided in paragraphs (1) and (2); 

16 ‘‘(B) submit to the Secretary an applica17 tion at such time, in such manner, and con18 taining such information as the Secretary re19 quires; and 

20 ‘‘(C) comply with such other terms and 

21 conditions as the Secretary shall establish to 

22 carry out this subsection. 

23 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

24 There are authorized to be appropriated $2,500,000 


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1 for each of the fiscal years 2010, 2011, and 2012, 

2 for financial assistance under this subsection. 

3 ‘‘(h) IMPACT OF INCOME ON ELIGIBILITY FOR HOUS4 ING BENEFITS.—For any resident of public housing who 

5 is trained as a home health aide or as a provider of home6 based health services pursuant to the program under sub7 section (f), any income received by such resident for pro8 viding covered home-based health services shall apply to9 wards eligibility for benefits under Federal housing pro10 grams as follows: 

11 ‘‘(1) No income received shall apply for the 12 

12 months after the completion of the training of such 

13 resident. 

14 ‘‘(2) 25 percent of income received shall apply 

15 for the period that is 12 to 24 months after the 

16 completion of the training of such resident. 

17 ‘‘(3) 50 percent of income received shall apply 

18 for the period that is 24 to 36 months after the 

19 completion of the training of such resident. 

20 ‘‘(4) 100 percent of income received shall apply 

21 for any period that begins after 36 months after the 

22 completion of the training of such resident.’’. 

Æ 


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