Policy Corner: June 25, 2021

Lawmakers Introduce Draft Proposal for the Better Care Better Jobs Act

Sens. Robert Casey, Jr. (D-Pa.), Ron Wyden (D-Wyo.), and Chuck Schumer (D-N.Y.), Patty Murray (Wash.), Tammy Duckworth (D-Ill.), Sherrod Brown (D-Ohio) and Maggie Hassan (D-NH), and Reps. Debbie Dingell (D-Mich.), Frank Pallone, Jr. (D-N.J.), Jan Schakowsky (D-Ill.), and Doris Matsui (D-Calif.) announced the draft of the bicameral Better Care Better Jobs Act introduced in both chambers. While the bill language is now available, bill numbers have yet to be assigned. The purpose of the bill is to expand home care for persons with disabilities or who are elderly while boosting caregivers’ wages. The bill is to condition the funds on states’ ability to shift people to home and community-based services from nursing homes, recruit and train more health workers, provide caregiver pay increases, and establish oversight capacity. The $400 billion Medicaid care plan, however, would allow states to opt-in, meaning states would determine whether to participate.

The legislation is part of the president’s plan to increase and expand human infrastructure, separate from the bi-partisan plan proposed yesterday to address the nation’s transportation, water, and broadband infrastructure needs. The President proposed separating his infrastructure agenda into separate bills.

BIAA Supports Increase for Lifespan Respite Care Program

The Brain Injury Association of America (BIAA) joined other national organizations in supporting $14.2 million in Fiscal Year 2022 Labor-Health and Human Services Education Appropriations bill for the Lifespan Respite Care Program, administered by the Administration for Community Living. This amount reflects the president’s budget recommendation to double funding for this program in the coming fiscal year. As respite is difficult to obtain for caregivers of individuals with brain injury, BIAA signed on to a letter to House and Senate appropriators supporting an increase for the program. Lifespan Respite systems maximize existing resources and require that respite become more accessible and available to all family caregivers.

Senators Submit Letter to Appropriators Requesting Additional Funding for TBI Programs

Sen. Chris Van Hollen (D-Md.) circulated a “Dear Colleague” letter to obtain support for additional funding for Traumatic Brain Injury (TBI) Act programs and for the National Institute on Disabilities, Independent Living, and Rehabilitation Research (NIDILRR) TBI Model Systems administered by the U.S. Department of Health and Human Services. Ten Senators signed on to the letter calling for a $12 million increase to fund the Administration for Community Living (ACL) TBI State Partnership Program, $6 million for the ACL TBI Protection & Advocacy Program, $6.6 million for ACL’s NIDILRR TBI research and model systems, and $5 million to the Centers for Disease Control and Prevention’s Injury Center to establish the National Concussion Surveillance System.

Legislators Sponsor Bills to Raise SSI Benefits

Reps. Raul Grijalva (D-Ariz.), Elissa Slotkin (D-Mich.), and Jan Schakowsky (D-Ill) introduced the Supplemental Security Income Restoration Act, H.R. 3763, while Sen. Sherrod Brown (D-Ohio) introduced a similar bill, S.2065, along with Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.), to increase the benefit rate to at least 100% of the Federal Poverty Level, adjusted annually for SSI benefits. The bills propose to end the marriage penalty for couples by increasing the SSI couples rate to equal two times the individual rate. Since SSI was signed into law in 1972, the income and eligibility rules have changed little and the program is no longer keeping people with disabilities from living in poverty.

SCOTUS Rules on Affordable Care Act Challenge

The U.S. Supreme Court. (SCOTUS) rejected another effort to dismantle the Affordable Care Act (ACA) in a 7-2 ruling June 17 in the case of California v. Texas. SCOTUS held that neither the states nor the individual plaintiffs have standing to challenge the constitutionality of the ACA. When Congress eliminated the penalty for individuals failing to obtain health insurance – referred to as the individual mandate – several states, the previous Administration, and individuals brought suit arguing that since Congress changed the penalty, the individual mandate no longer applied. Soon after President Biden took office, the administration notified the justices that the new administration no longer held the same position as the previous administration and said that should SCOTUS throw out the individual mandate, to leave other provisions in place, such as essential health benefits, coverage for individuals with pre-existing conditions, and prohibiting insurers from placing annual and lifetime caps on insurance coverage.

Administration Provides Direction on Enhanced FMAP for Medicaid HCBS

The Centers for Medicare & Medicaid Services (CMS) issued guidance on how states can receive enhanced funding through the American Rescue Plan Act of 2021 (ARP), to increase access to home and community based-services (HCBS) for Medicaid beneficiaries. Section 9817 of the ARP provides states with a temporary 10% increase to the federal medical assistance percentage (FMAP) for certain Medicaid HCBS from April 1, 2021 through March 31, 2022, to improve HCBS under the Medicaid program. While spending plans were due June 12, CMS has conveyed to states that they can request an additional 30 days to submit. The state is to obtain input from stakeholders on the use of the increase in the federal match, which has to be used to supplement, not supplant existing Medicaid HCBS waiver and State Plan services.

The guidance emphasizes that states must (1) maintain their HCBS eligibility standards, benefits (including amount, duration, and scope), and provider rates in effect on April 1, 2021; and (2) use the new funds to enhance, expand, or strengthen HCBS. This is an excellent opportunity for states to expand populations to include brain injury and could do so by changing assessment tools or other ways to ensure people are served, expanding services, such as rehabilitation, behavioral health, and substance use treatment for people with co-occurring conditions, and raising provider rates to recruit and maintain providers. The National Association of State Head Injury Administrators (NASHIA) has reached out to members to obtain their state’s spending plans that may expand HCBS opportunities for people with brain injury. NASHIA and BIAA encourage advocates to participate in public forums and other opportunities to provide input with regard to HCBS for people with brain injury.

BIAA gratefully acknowledges the Centre for Neuro Skills and Avanir Pharmaceuticals for their support for legislative action. Click here to read past issues of Policy Corner.