An ambitious plan to shore up Medicaid home and community-based services nationwide with the largest investment ever in the program has been whittled down to nothing.

After more than a year of negotiation, President Joe Biden is expected to sign a reconciliation bill tackling climate change and health care costs. The legislation now known as the Inflation Reduction Act is the latest iteration of a what was originally expected to be a much more expansive measure encompassing Biden’s Build Back Better agenda, including $400 billion in spending on home and community-based services.