Bipartisan Infrastructure Deal Complicates Path for $400B Home Care Investment; Senators Advance Separate HCBS Bill

Situation Report | June 28, 2021  

President Biden last week agreed to the terms of a scaled-back infrastructure package brokered by a bipartisan group of Senators. The consensus package, however, leaves an uncertain path for the President’s plan to invest billions in home and community-based services. 

In April, as we previously reported, the President announced a $2 trillion infrastructure plan with investments in affordable housing, roads, bridges, broadband, the power grid, and public works. But the largest component of his plan, by far, was a proposal to fund home and community-based services — at $400 billion over eight years.

Republicans have sought to scale back the overall size and scope of the package, calling for funds targeted exclusively to what might be called “traditional” infrastructure projects, like roads and bridges. Last week’s bipartisan package appears to reflect that push-and-pull, omitting the President’s home care proposals among others for a variety of reasons, including differences over revenue actions like proposed tax increases.

However, Senate Democrats are reportedly moving forward on a separate “reconciliation” bill to include some pieces of the President’s original plan that are otherwise rejected from the bipartisan package. This reconciliation package may take up whatever parts of the President’s larger infrastructure package are excluded from any final bipartisan agreement.   

Democrats would appear to be approaching the President’s goals in two parts: first, through a smaller bipartisan package that could win at least 60 Senate votes to surmount a filibuster challenge; and then, secondly, by addressing some of the more contentious items using a parliamentary move called “reconciliation” to bypass a filibuster threat.

While the reconciliation bill is still being crafted, it is unclear at this time whether the home care proposals, specifically, are under consideration.

Standalone Home Care Bill Emerges

Meanwhile, a group of Senators on Thursday introduced the Better Care Better Jobs Act, which would provide states with enhanced Medicaid funding for home and community-bases services, adapting a version of the President’s original proposal. The bill is sponsored by U.S. Senators Bob Casey of Pennsylvania and Ron Wyden of Oregon. A House version is sponsored by U.S. Representative Debbie Dingell of Michigan.

Specifically, the bill would provide $100 million for states to develop plans to expand access to Medicaid home and community-based services (HCBS) and strengthen the HCBS workforce.

It would also provide states with a 10-percentage point increase in the Medicaid Federal Medical Assistance Percentage (FMAP) for HCBS and an enhanced federal match of 80 percent for administrative activities associated with improving HCBS programs. This enhanced match has been described as a more permanent version of the one-time FMAP enhancement that was provided to states in the most recent coronavirus relief package.

To receive the funds, states would have to meet certain conditions like: addressing access barriers and disparities; expand financial eligibility criteria for HCBS to the federal limit; expand supports for family caregivers (including respite care); “address insufficient payment rates for HCBS to promote access and improve workforce recruitment and retention”; update HCBS payment rates every two years “through a transparent process with input from stakeholders”; and several other provisions.

HCA will continue our outreach to the Congressional Delegation urging support for home and community-based services and infrastructure. Please stay tuned for further updates as we learn about key developments in the process.