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BCBJ Act Faces Complicated Path to Passage

  • Government Affairs,
  • healthcare advocacy,
  • Medicaid HCBS

Congress has introduced the Better Care Better Jobs Act (H.R. 4131 / S.2210) to operationalize and expand President Biden's proposal for a $400 billion investment in the Medicaid Home and Community-Based Services (HCBS) program. This is a clear sign that both Congress and the Biden administration are seriously exploring ways to remedy the direct support professional (DSP) workforce crisis.


This legislation proposes historic investments to transform and expand the HCBS program, strengthen the DSP workforce, pay providers sufficient Medicaid reimbursement rates, and improve outcomes for seniors and people with disabilities. The timing couldn’t be better—with the DSP workforce facing more recruitment challenges than ever and our nation still recovering from the pandemic, this legislation is sorely needed.

Specifically, the bill:

  • Creates a 10-percent Medicaid FMAP increase for Home and Community-Based Services, including a multi-year increase in Medicaid rates for states to shore up and strengthen services and supports for seniors and adults with disabilities.
  • Strengthens the DSP workforce by making direct investments in training, recruitment, and retention.
  • Innovates, improves, and expands access to services by mandating that funding must be used by states to improve quality of services, increase workforce wages, and address access to care issues.
  • Creates accountability through quality measurement by establishing core and supplemental sets of quality measures by which services could be benchmarked and with which states can track quality of care.
  • Makes permanent the Money Follows the Person (MFP) program. MFP is currently a demonstration pilot that must be frequently renewed, and each pause for renewal disrupts funding to help people with disabilities move into the community.


However, this bill faces a complicated path to passage. Changes to the text of the Better Care Better Jobs Act are likely, especially if it ends up being included in a bigger infrastructure package currently being prepared for the reconciliation process. The reconciliation process is long and complicated—it will take all summer, with a vote not likely before the fall. That means there will be many moments when this bill will either face changes or risk of being removed from the package to keep costs down.