On Thursday, October 28^th, the House rules committee released updated legislative text for the Build Back Better Act, which would enact large parts of President Biden’s domestic agenda. The proposal, if passed into law as written, would have significant impacts for Medicaid LTSS as well as aging & disability programs. Notably, the bill:

• Allocates an estimated $150 billion for Medicaid HCBS, which includes:
  • A permanent 6% FMAP increase to states that meet all the applicable requirements;
  • A temporary additional 2% FMAP increase for states that implement a self-direction program that includes certain defined criteria;
  • A permanent reauthorization of the Money Follows the Person program, funded at $450 million a year; and
  • A permanent extension of the Affordable Care Act’s Medicaid spousal impoverishment protections.
• Allocates approximately $1.2 billion for OAA;
• Provides a retroactive waiver OAA of the state/local match contained in ARPA;
• Adds a new hearing – but not dental nor vision – benefit to the Medicare program;
• Provides new funding and reauthorization for the Elder Justice Act, including additional APS funding;
• Provides $1 billion to ACL for HCBS workforce development, training and retention grants; and
• Includes $900 million for housing supports to older adults and people with disabilities.

Although it is unclear whether this proposal currently has sufficient support to pass Congress, we do believe that the Democratic majority will ultimately pass a reconciliation bill that President Biden will sign into law. We believe that the provisions related to the Medicaid HCBS funding is likely to be included in the final deal. However, it is less clear whether the OAA and EJA provisions will make it into the final package. We do note that significant negotiations are ongoing and there is a chance that policy and funding levels could shift further, including some of the aging and disability programs.

For the full analysis, click here.