Capitol Correspondence - 09.14.21

The Committee on Energy & Commerce Recommends $190 Billion for HCBS—Less Than Half Promised by President Biden, Senate Dems

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The U.S. House Committee on Energy & Commerce recently released its recommendations for the budget resolution, and the recommendations include $190 billion for home- and community-based services (HCBS).

The House Committee on Energy & Commerce is responsible for the markups to the budget resolution specific to Medicaid investments. The Committee issued a fact sheet earlier in the week sharing the House’s intention to invest $190 billion  in HCBS. With the Senate Finance Committee instruction requiring $1 billion in overall deficit reduction, all proposals in the human infrastructure package experienced a reduction to ensure an overall net budget savings. However, $190 billion is a drastic reduction from the the $400 billion initially proposed in President Biden’s American Jobs Plan and the Better Care Better Jobs Act.  

Shortly thereafter, the House Committee on Energy & Commerce released the full text of the Budget Reconciliation Legislative Recommendations Relating to the Medicaid Program. In addition to the topline funding reduction, there are pointed differences between the Better Care Better Jobs Act and the budget recommendations. In order to accommodate the new $190 billion funding line, the HCBS FMAP increase (i.e., the increase in the federal matching rate) for each quarter was reduced from 10 percentage points to 7 percentage points.

Other high-level changes include:

  • Expanding the payment review process from every two (2) years to every three (3) years.
  • Explicit direction in the maintenance of effort provision to use the funding to supplement, not supplant, including prohibition against reducing payment rates for HCBS.
  • Removal of the benchmark criteria requiring “evidence that a majority of direct care workers receive competitive wages and benefits.”