The Build Back Better Act: $150 Billion for Medicaid HCBS Funding and Other Important Programs

On Wednesday, ANCOR sent a letter to Senate Majority Leader Chuck Schumer, Senate Minority Leader Mitch McConnell, House Speaker Nancy Pelosi, and House Minority Leader Kevin McCarthy urging them to include funding for Medicaid Home and Community Based Services (HCBS) in the final budget reconciliation bill, the Build Back Better Act.

The following day, the White House released its framework for the $1.75 trillion budget Build Back Better Act. Included in the framework is a line item of $150 billion for Medicaid HCBS. Congress also released the text of the Build Back Better Act ahead of last Thursday’s House Rules Committee hearing on the bill.

Key provisions in the Build Back Better Act include:

• Increased funding for Medicaid HCBS. States are eligible for a 6 percentage point increase in their FMAP (i.e., an increase in the federal matching rate for Medicaid funding) for HCBS, with an additional 2 percentage-point increase for HCBS during the first six fiscal quarters throughout which the state has implemented and has in effect a program to support self-directed care.
• Increased frequency of payment rates for HCBS providers. Payment rates must be updated two years after each state’s HCBS improvement plans are approved and then every three years thereafter.
• Permanent extension of Medicaid protections against spousal impoverishment.
• Permanent extension of the Money Follows the Person program.
• $270 million for a grant program to assist states that choose to phase out 14c certificates (i.e., those that enable providers to pay Medicaid beneficiaries subminimum wages).
• $1 billion over a ten-year period to support the direct care workforce through renewable three-year grants from the U.S. Department of Labor, in coordination with the Department of Health and Human Services’ (HHS) Administration for Community Living, to invest in strategies to recruit, retain, and advance the direct care workforce; implement models and strategies to make the field of direct care more attractive; and improve wages, including through training and registered apprenticeships, career pathways, or mentoring.