Better Care Better Jobs Act passes

The “Big, Beautiful Bill” (BBB), informally referenced in policy circles, encapsulates a comprehensive legislative initiative aimed at strengthening the U.S. care infrastructure, with particular emphasis on behavioral health services, Medicaid reform, and home- and community-based services (HCBS). This bill prioritizes system-wide reform, addressing service access, workforce sustainability, and family support across levels of prevention—primary, secondary, and tertiary.

The most critical feature of the bill is the expansion of Medicaid HCBS. By increasing federal funding and enabling broader eligibility, this provision ensures individuals with developmental disabilities, including autism, can access supports that enable them to remain in their homes and communities rather than institutions. This aligns with the principles of primary prevention, aiming to reduce the need for intensive interventions by supporting individuals early and within naturalistic environments (Musumeci & Chidambaram, 2021).

Closely following in importance is workforce stabilization. The bill addresses long-standing workforce shortages by mandating increased wages, structured training, and improved retention strategies for direct support professionals (DSPs). These efforts, serving a secondary prevention function, are designed to build a competent, stable workforce that can deliver consistent and quality care (Scales & Leber, 2021).

Another pivotal aspect of the bill is the inclusion of caregiver and family support. Funding for respite services, caregiver education, and financial assistance targets tertiary prevention by helping families manage the long-term challenges of caregiving and reducing caregiver burnout, which is associated with placement breakdowns and crisis intervention needs (Feinberg et al., 2020).

Furthermore, the bill incorporates accountability mechanisms to ensure equitable access and transparency in state-level implementation. This includes mandatory reporting on service utilization and outcomes, particularly for marginalized communities—a key measure to prevent systemic neglect and inefficiencies (Congressional Budget Office, 2021).

Equally notable is the proposed permanent increase in the Federal Medical Assistance Percentage (FMAP) for HCBS. By solidifying federal contributions, this element supports sustainable service delivery and long-term program planning, reinforcing primary prevention through stable funding models (Ng, Stone, & Harrington, 2021).

Lastly, the bill allocates funds to expand behavioral health infrastructure, including data modernization and telehealth capacity. These investments are essential to address service deserts and continuity of care, particularly for rural and underserved populations, serving a tertiary prevention function through crisis avoidance and service continuity (Torous et al., 2020).

The Big, Beautiful Bill outlines a multi-pronged, prevention-focused legislative strategy to reinforce the behavioral health system, protect vulnerable populations, and empower families. Through strategic investments in workforce, infrastructure, and equitable service expansion, the bill offers a blueprint for long-term care reform grounded in public health and social equity.

References

Musumeci, M., & Chidambaram, P. (2021). *Key Questions About the Better Care Better Jobs Act and Home and Community-Based Services.* KFF.

Scales, K., & Leber, C. (2021). The Direct Care Workforce: Health Affairs, 40(6), 926–932. https://doi.org/10.1377/hlthaff.2021.00356

Feinberg, L., et al. (2020). Family Caregiving and Health Policy: Where to From Here? The Gerontologist, 60(S1), S79–S85. https://doi.org/10.1093/geront/gnaa027

Congressional Budget Office. (2021). Cost Estimate for the Better Care Better Jobs Act.

Ng, T., Stone, J., & Harrington, C. (2021). Medicaid Home and Community-Based Services: Journal of Aging & Social Policy, 33(4–5), 375–395.

Torous, J., et al. (2020). Digital Mental Health and Telepsychiatry in the Era of COVID-19. Psychiatric Services, 71(5), 492–494.