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President Biden has proposed a significant investment into the Medicaid Home and Community Based Services Program with the goals of improving access to care in the home and addressing workforce challenges. Senator Bob Casey (D-PA) and Congresswoman Debbie Dingell (D-MI) have carried out this proposal in legislative form with the Better Care Better Jobs Act.

This legislation takes several steps to improve Medicaid HCBS, first through providing funding to state Medicaid programs to ready themselves for the enhanced investment, then through a 10% increase to the Federal Medicaid Assistance Percentage (FMAP) specifically for Medicaid HCBS.

In order to qualify for the enhanced 10% FMAP states would be required to provide coverage for personal care services; expand supports for family caregivers; adopt programs that help people navigate enrollment and eligibility; expand access to behavioral health care; improve coordination with housing, transportation, and employment supports; and develop or improve programs to allow working people with disabilities to access HCBS.

In addition, the bill would strengthen and expand the HCBS workforce by addressing HCBS payment rates to promote recruitment and retention of direct care workers; regularly updating HCBS payment rates with public input; passing rate increases through to direct care workers to increase wages; and updating and developing training opportunities for this workforce as well as family caregivers.

Lastly, the legislation would permanently authorize protections against impoverishment for individuals whose spouses are receiving Medicaid HCBS and make the Money Follows the Person Rebalancing Demonstration permanent.