What the Build Back Better Legislation Means for Home Care

The Build Back Better (BBB) plan is a $1.85 trillion social spending package released last week by the House of Representatives and NAHC has analyzed the legislation to see how it will impact our members and the wider home care and hospice community.

  • Bill text can be found HERE
  • A section-by-section overview of the bill’s provisions can be found HERE
  • A summary post on the bill’s framework developed by the White House can be found HERE

The BBB bill is the cornerstone of President Biden’s and congressional Democrats’ domestic agenda. Initially proposed spending targets for the package were around $3.5 trillion, but lack of Democratic consensus on the topline figure and scope, as well as narrow margins for Democrats in both the House and Senate forced lawmakers to shrink the overall size and ambition of the bill. This legislation will impact nearly every sector of American society, and there are a number of policies with direct relevance for home health, home care, and hospice providers, some of which are NAHC advocacy priorities.

Agreement on the BBB framework was supposed to result in a House vote this week on the “hard infrastructure” package that passed the Senate months ago. However, that vote was delayed once more, as House progressives indicated they would withhold support for the infrastructure deal until it becomes clearer that the Senate is on-board with the BBB legislative details. More negotiations are expected in the coming days, but the release of the House bill this week provides the clearest signal yet of what will ultimately be in a final package.

Below is background information on some of those most consequential policies included in the House BBB legislation:

Medicaid Home and Community-Based Services (HCBS) Investment (“Better Care Better Jobs Act”)

  • $150 billion investment to bolster Medicaid HCBS, with the goal of increasing access to services, reducing waitlists, and better supporting the direct care workers that provide the bulk of HCBS. Specifically, the approved language would:
    • Provide a 6% FMAP increase for HCBS
    • Require coverage of personal care services
    • Require caregiver supports such as respite care
    • Require updated of payment rates that “support the recruitment and retention of the direct care workforce.
    • Require an update of HCBS payment rates at least every three years.
    • Make permanent the protections against spousal impoverishment for recipients of Medicaid HCBS.
    • Make permanent the Medicaid Money Follows the Person (MFP) demonstration that helps those in institutional facilities transition back to the community.
      • See the legislative language for this provision HERE
      • See an overview of the provision HERE

Direct Care Worker Training and Support Investments

  • $400 million/yr for FY2023-2026 for a grant-based program that would bolster frontline caregivers’ access to economic and educational supports. These grants would go to states and territories, to be spent on things like worker wage subsidies, student loan repayment or tuition assistance for a degree or certification in a relevant field, childcare for eligible workers, and transportation assistance, amongst other approved activities that benefit direct care workers. The bill makes clear that aides working in home health, personal care, and hospice, as well as LPNs and LCSWs, are eligible to receive support under these grants.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $1 billion over 10 years for a separate program to support the direct care workforce through renewable three-year grants administered by the Dept of Labor. Grants can be used 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.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE
  • $20,000,000 to fund a national technical assistance center through HHS’ Administration for Community Living which will develop and disseminate evidence-based strategies for recruitment, education and training, retention, and career advancement of direct care workers and provide recommendations for activities to further support paid and unpaid family caregivers.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Additional Health Workforce Investments

  • $400 million for the Health Profession Opportunity Grant (HPOG) program, which awards grants to organizations to provide education and training to low-income individuals for occupations in the health care field that are expected to either experience labor shortages or be in high demand. Home care and home health aides are identified as being HPOG-eligible professions.
    • See the legislative language for this provision HERE
    • See an overview of the provision HERE

Major provisions that were not incorporated into the House bill include paid family and medical leave, a tax credit for family caregivers, Medicare drug price negotiation, and new Medicare dental and vision benefits.

As Congressional negotiations progress, NAHC will continue to advocate for the inclusion in the reconciliation package of additional polices that will benefit patients, families and the home-based providers that care for them. We are closely tracking the movement on this massive bill, and will be updating members on relevant developments as they arise.