November 19, 2021

This morning, the House of Representatives passed the Build Back Better Act, a $1.7 trillion-dollar social spending package. You can view the bill text here, and a section-by-section summary here. While the Senate is likely to modify the bill significantly, we want to provide a snapshot below of where everything currently stands.

Key Provisions Passed in the House Version:

• Home and Community Based Services (HCBS) – Invests $150 billion in Medicaid HCBS, with a focus on the caregiver workforce; includes a 6% FMAP increase for states that implement an HCBS Improvement Program.
• Certified Community Behavioral Health Clinics – Includes in full the Excellence in Mental Health and Addiction Treatment Act (S. 2069/H.R. 4323).
• Incentivizing Mobile Crisis Care – Makes permanent a state option to provide community-based mobile crisis intervention services.
• Medicaid Reentry Act – Allows for Medicaid coverage for eligible incarcerated individuals up to 30 days before their release from jail or prison.
• Affordable Care Act/Medicaid Expansion – Expands ACA marketplace subsidies through 2025; expands eligibility in non-expansion states; expands access to maternal health (12-month continuous coverage for pregnant & postpartum women); permanently extends the Children’s Health Insurance Program; and assists state Medicaid programs in responding to the COVID-19 public health emergency.
• Parity Enforcement – Gives the Department of Labor the authority to impose civil monetary penalties on insurance providers who are in violation of the Mental Health Parity and Addiction Equity Act.
• Federal Paid Medical Leave – Provides up to four weeks of paid medical leave, including treatment for mental illness and substance use disorder.

Read this report for a comprehensive breakdown of these proposed policies.

Next Steps

The reconciliation measure now heads to the Senate, where further modifications to the legislative text are likely to occur. The Senate Parliamentarian’s office is expected to begin reviewing the bill as soon as it is formally reported. Anything found in violation of the chamber’s Byrd rule – which bans provisions that are viewed as “extraneous” to the budget from being tacked onto reconciliation bills – will be struck from the legislation. Additional tweaks may also be needed to appease Sens. Joe Manchin (D-WV) and Kyrsten Sinema (D-AZ), who have expressed uneasiness with a larger spending package due to underlying economic concerns.