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Capitol Correspondence - 12.17.21

Senate Build Back Better Act Draft Language Maintains Historic $150 Billion Investment in HCBS

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This week the Senate Finance Committee and Senate Health, Education, Labor, and Pensions (HELP) Committee released their drafts of the Build Back Better Act this week. The updated language maintains the nearly $150 billion investment in Medicaid Home and Community Based Services (HCBS).

The committees’ draft language is subject to review by the Senate Parliamentarian to ensure it comports with the Byrd Rule—the process which governs budget reconciliation legislation—meaning that committees’ draft language will likely change. However, at this moment, the HCBS provision remain with little significant changes from the House-passed version of the bill.

Below are the key ANCOR priorities currently included in the Senate text:

  • Medicaid HCBS: The bill maintains the historic investment of nearly $150 billion for Medicaid HCBS, which would provide a 6 percentage-point increase in the federal matching (FMAP) rate over a 10-year period and a potential additional 2 percentage-point increase in the FMAP rate for states that implement a program for self-directed care.
  • Payment rates: The HCBS provision also includes a requirement that states will review payment rates, starting two years after the approval of each state’s HCBS improvement plan and then every three years thereafter.
  • Money Follows the Person and Protections Against Spousal Impoverishment: The draft text includes permanent reauthorization of the Money Follows the Person and Protections Against Spousal Impoverishment programs.
  • Direct care workforce investments: The Senate language maintains the $1 billion grant program to invest in strategies to recruit, retain, and advance the direct care workforce.
  • Competitive integrated employment: The Senate language also maintains the $270 million grant program for states to assist employers that choose to transition from 14(c) certificates to competitive integrated employment programs.
  • Assistance to Intermediate Care Facilities (ICFs): The Senate bill provides $800 million for the Improve Staffing and Infection Control in Long-Term Care Institutional Settings grant program (funds may be used to provide wage or benefits enhancements, improve and develop training and career development opportunities, and to expand staffing of one or more types of eligible workers so as to increase staffing ratios). The language also increases the funding for the Nursing Home Worker Training Grants, which include ICFs as eligible entities, to $1.6 billion (funds may be used for wage subsidies, student loan repayment or tuition assistance, affordable and accessible child-care, obtaining appropriate transportation).

ANCOR will continue to provide updates as the Build Back Better Act continues to be negotiated in the Senate and as any of these provisions undergo significant change.

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