Better Care, Better Jobs Act (H.R. 4131 and S. 2210)

U.S. Senate bill: S. 2210, introduced by Senator Robert Casey (D-PA) — Better Care, Better Jobs Act

Committees:

Senate Committee on Finance

Status:

Modified versions of this legislation (with reduced funding levels) were included in the Build Back Better Act, which ultimately passed the House.

Cosponsors:

39 (see all cosponsors)

Cosponsor Date Cosponsored
Sen. Wyden, Ron [D-OR]* 06/24/2021
Sen. Schumer, Charles E. [D-NY]* 06/24/2021
Sen. Murray, Patty [D-WA]* 06/24/2021
Sen. Duckworth, Tammy [D-IL]* 06/24/2021
Sen. Brown, Sherrod [D-OH]* 06/24/2021
Sen. Hassan, Margaret Wood [D-NH]* 06/24/2021
Sen. Gillibrand, Kirsten E. [D-NY]* 06/24/2021
Sen. Whitehouse, Sheldon [D-RI]* 06/24/2021
Sen. Durbin, Richard J. [D-IL]* 06/24/2021
Sen. Baldwin, Tammy [D-WI]* 06/24/2021
Sen. Markey, Edward J. [D-MA]* 06/24/2021
Sen. Blumenthal, Richard [D-CT]* 06/24/2021
Sen. Warren, Elizabeth [D-MA]* 06/24/2021
Sen. Reed, Jack [D-RI]* 06/24/2021
Sen. Shaheen, Jeanne [D-NH]* 06/24/2021
Sen. Van Hollen, Chris [D-MD]* 06/24/2021
Sen. Smith, Tina [D-MN]* 06/24/2021
Sen. Merkley, Jeff [D-OR]* 06/24/2021
Sen. Booker, Cory A. [D-NJ]* 06/24/2021
Sen. Leahy, Patrick J. [D-VT]* 06/24/2021
Sen. Padilla, Alex [D-CA]* 06/24/2021
Sen. Schatz, Brian [D-HI]* 06/24/2021
Sen. Klobuchar, Amy [D-MN]* 06/24/2021
Sen. Kaine, Tim [D-VA]* 06/24/2021
Sen. Bennet, Michael F. [D-CO]* 06/24/2021
Sen. Warnock, Raphael G. [D-GA]* 06/24/2021
Sen. Sanders, Bernard [I-VT]* 06/24/2021
Sen. Peters, Gary C. [D-MI]* 06/24/2021
Sen. Lujan, Ben Ray [D-NM]* 06/24/2021
Sen. Heinrich, Martin [D-NM]* 06/24/2021
Sen. Hirono, Mazie K. [D-HI]* 06/24/2021
Sen. Stabenow, Debbie [D-MI]* 06/24/2021
Sen. Feinstein, Dianne [D-CA]* 06/24/2021
Sen. Rosen, Jacky [D-NV]* 06/24/2021
Sen. Cardin, Benjamin L. [D-MD]* 06/24/2021
Sen. Murphy, Christopher [D-CT]* 06/24/2021
Sen. Cantwell, Maria [D-WA]* 06/24/2021
Sen. Menendez, Robert [D-NJ]* 06/24/2021
Sen. King, Angus S., Jr. [I-ME]* 06/24/2021

U.S. House bill: H.R. 4131, introduced by Representative Debbie Dingell (D-MI-12) — Better Care, Better Jobs Act

Committees:

House Committee on Energy and Commerce

Status:

Modified versions of this legislation (with reduced funding levels) were included in the Build Back Better Act, which ultimately passed the House.

Cosponsors:

149 (see all cosponsors)

 

Impact

“President Biden is calling on Congress to make substantial investments in the infrastructure of care in our country. Specifically, he is calling on Congress to put $400 billion toward expanding access to quality, affordable home- or community-based care for aging relatives and people with disabilities. These investments will help hundreds of thousands of Americans finally obtain the long-term services and support they need…President Biden’s plan will: (e)xpand access to long-term care services under Medicaid. President Biden believes more people should have the opportunity to receive care at home, in a supportive community, or from a loved one. President Biden’s plan will expand access to home and community-based services (HCBS) and extend the longstanding Money Follows the Person program that supports innovations in the delivery of long-term care…”

                         The White House, The Fact Sheet: The American Jobs Plan (March 31, 2021)

 

“Congresswoman Debbie Dingell (D-MI), Senator Maggie Hassan (D-NH), Senator Bob Casey (D-PA), and Senator Sherrod Brown (D-OH) today released a discussion draft of the HCBS Access Act for stakeholder feedback. The proposal seeks to mandate HCBS in Medicaid to provide critical services, creating national, minimum requirements for home and community-based services, and make it possible to enhance those services and the long-term care workforce.”

                                                      Joint Press Release (March 16, 2021)

NAEH is pleased with Washington, DC’s, interest in expanding Medicaid’s Home and Community-Based Services (HCBS) program because it represents an historic opportunity to provide people experiencing homelessness with the supportive housing services some of them need to stay safely and securely housed.  It may not have always been the intent to revamp HCBS in a way which helps people experiencing homelessness, but people seem pleased when they hear that it’s a fortuitous byproduct.

Of the 580,000 people experiencing homelessness on a given night, some need help (health care, casework, housing navigation, and landlord intervention) to find a suitable place to live and remain housed.  Chronically homeless people, about 120,000 people on a given night, are people who have spent a long time outdoors and suffer from a disability, mental illness, or substance abuse problem, and need supportive housing services.  Chronically homeless people, because of their greater visibility, are the people experiencing homelessness with whom lawmakers are most familiar.  State and local governments are eager to help them get off the streets and into permanent housing because of the significant costs avoided for emergency room care, law enforcement, and corrections, in addition to humanitarian concerns. 

Ideally, people experiencing chronic homelessness receive permanent supportive housing (PSH), which combines a complete rental subsidy and voluntary support services that address their needs in ways that promote independent living and tenancy skills and connects them with community-based health care, treatment and employment services.  But that can be expensive, and often communities only get enough new funding through the annual appropriations process (pursuant to the Continuum of Care program which is funded by the Transportation-Housing and Urban Development (THUD) Appropriations Bill) to pay for their existing PSH obligations, but not enough to take on new cases. 

Consequently, inspired by Social Determinants of Health thinking, i.e., that spending on factors which affect our health, like housing, can ultimately reduce our overall health care costs, Medicaid waivers have been granted during both the Obama and Bush Administrations, to pay for supportive housing services, although not rent, on a budget neutral basis—and they seem to be meeting with much success, particularly in Washington and Minnesota. 

President Biden, in his campaign platform, FY22 budget request, and infrastructure investment proposal, has committed to greatly expanding the federal government’s effort to make housing more affordable for low-income Americans.  That is also a welcome development.  But as discussed: some people experiencing homelessness need more than rental subsidies to stay safely and securely housed—they need supportive housing services as well. 

NAEH strongly endorses the Better Care, Better Jobs Act (H.R. 4131, S. 2210), which would expand Medicaid’s HCBS program to provide home health care to the elderly and the disabled, including supportive housing services for people experiencing homelessness with acute needs.  Modified versions of this legislation (with reduced funding levels) were included in the Build Back Better Act, which ultimately passed the House.  Urge your lawmakers to ensure that any such package include a significant investment in home health care.  

Summary

NAEH strongly endorses the Better Care, Better Jobs Act (H.R. 4131, S. 2210), which would expand Medicaid’s HCBS program to provide home health care to the elderly and the disabled, including supportive housing services for people experiencing homelessness with acute needs.  Modified versions of this legislation (with reduced funding levels) were included in the Build Back Better Act, which ultimately passed the House.  Urge your lawmakers to ensure that any such package include a significant investment in home health care.  

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