Better Care Better Jobs Act
Overview
Type of Reform: Reforming Medicaid Structures
Description: Creates new programs and funding for state Medicaid programs to improve HCBS and the direct care workforce by:
- Requiring states to submit an HCBS infrastructure improvement plan to increase access to HCBS and strengthen the direct care workforce.
- Increasing federal matching rate for HCBS in states that develop plans and meet specified benchmarks for improvements.
- Requiring states to expand financial eligibility criteria for HCBS up to federal limits.
- Requiring states to implement Medicaid buy-in programs for workers with disabilities.
- Making permanent:
- The Money Follows the Person Rebalancing Demonstration Program (grant program to help states increase use of HCBS and decrease the use of institutional care).
- Certain provisions regarding Medicaid eligibility that protect against spousal impoverishment for recipients of HCBS.
Sponsor/Cosponsors:
- Introduced by Sen. Bob Casey (D-PA) on January 23, 2023.
- 41 co-sponsors.
Impact and Action:
Senate Committee Referrals: Finance.
Program Details
Participation Criteria
Medicaid enrolled individuals (criteria varies by state).
Conditions for Receiving Benefits Scope of Services
Criteria for receiving HCBS varies by state.
Scope of Services
Requires states to cover:
- Personal care services for all eligible populations receiving HCBS in the state.
- Community-based behavioral health services that are coordinated with employment, housing, and transportation supports.
- Family caregiver supports, including providing respite care, and may include providing such services as caregiver assessments, peer supports, or paid family caregiving.
Amount of Services
Not specified.
Participant Financial Responsibility
Not specified; varies by state.
Elimination Period
Not applicable.
Provider Requirements
Not specified.
Provider Payment Levels
- Requires states to evaluate sufficiency of and regularly update HCBS payment rates.
- Enacts processes to ensure that rate increases are passed through to direct care workers to increase wages.
Inflation Adjustments
Not specified.
Financing & Implementation
Revenue Source(s)
Not specified.
Total Program Costs
No cost estimate available.
Program Administration
- HHS oversees state administration and operation of new Medicaid provisions.
- States newly required to:
- Adopt HCBS quality measures.
- Designate an Ombudsmen office to help individuals navigate HCBS programs.
- Meet maintenance of effort requirements for amount, duration, and scope of and eligibility for HCBS in order to receive planning grants.
- Involve individuals who are recipients of HCBS, unpaid caregivers, providers, health plans, direct care workers, and aging, disability, and workforce advocates in HCBS improvement planning.
- Federal Medicaid matching rates increase:
- By 10% (not to exceed 95%) for HCBS, including administrative costs of expanding HCBS.
- To 80% for quality management activities (see above).
Better Care Better Jobs Act, 2023 (S.100/H.R. 547)
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