Combating Loneliness Act

(1) 36 percent of individuals in the United States report serious loneliness.

(2) 61 percent of young adults and over 50 percent of mothers with young children in the United States report serious loneliness.

(3) 61 percent of disabled individuals in the United States experience chronic loneliness, with an even higher prevalence of 70 percent among young disabled people in the United States.

(4) LGBTQI+ youth, particularly transgender and Black individuals, experience higher levels of loneliness, depression, and anxiety than their straight or cisgender counterparts.

(5) Black individuals, Indigenous individuals, and individuals of color are disproportionately affected by social loneliness and isolation, with 75 percent of Latinx and Hispanic adults and 68 percent of Black and African American adults categorized as lonely.

(6) Due to fragmented social networks, loneliness is especially pervasive with people experiencing homelessness, with 1 in 5 reporting to have no friends.

(7) Farmers and agricultural workers, predominantly based in rural areas, face heightened risks to mental well-being due to social and geographical isolation.

(8) Older adults face heightened vulnerability to loneliness and social isolation due to factors including living alone, loss of familial and social ties, chronic illness, and impaired hearing.

(9) Elderly individuals are increasingly affected by homelessness and loneliness as their social circles shrink, lifespans increase, and economic challenges grow, making them one of the fastest-growing segments of the homeless population.

(10) Veterans often experience feelings of isolation due to losing touch with their military community, physical or mental health issues, and difficulties adjusting to civilian life.

(11) 1 out of every 5 veterans reports that they often feel lonely, leading to higher rates of mental and physical health, as well as suicidal ideation.

(12) Climate-related disasters are associated with negative impacts on mental health nationwide.

(13) People who use social media for more than 2 hours a day are twice as likely to report increased feelings of social isolation than those who were using it for less than 30 minutes a day.

(14) Students with low academic performance may turn to social networking sites to cope with feelings of loneliness and isolation, finding online interactions less stressful than face-to-face relationships.

(15) A shortage of 139,000 primary care physicians is projected by 2033, with particularly concerning deficits anticipated rural areas.

(16) Burnout rates reported by health care workers nationally are higher than in any other industry.

(17) Nearly half of health workers reported often feeling burned out in 2022, up from 32 percent in 2018.

(18) Rural clinics report the highest rates of burnout.

(19) Increased feeling of loneliness and social isolation can lead to an increase in susceptibility to radicalization and violence.

(20) Increased feelings of loneliness lead to a reduced sense of civic duty and lower voter turnout.

(21) Positive relationships with peers, parents, and teachers during childhood and adolescence correlate with improved academic outcomes and predict higher rates of college graduation and attainment of four-year degrees in early adulthood.

(22) Building design incorporating elements that promote physical activity and social interaction enhances health and reduces loneliness among older adults.

(23) Housing with care is effective at reducing loneliness and social isolation in later life, providing better outcomes than living in the general community.

(1) create a national health insurance program that provides comprehensive and essential care to all individuals in the United States, which is critical to building healthier communities;

(2) establish a national paid family and medical leave program that allows every worker to take care of their own health and their families’ health, which creates healthy and vibrant communities;

(3) encourage participation in the arts and the humanities, which provides communities with a foundation to engage in our democracy and fosters an appreciation for our shared cultural heritage;

(4) establish universal early education that supports early childhood development and sets children up for academic success, which is an investment in our children, their families, and future generations;

(5) provide safe, affordable housing that provides working families with stability, which is critical to building vibrant communities;

(6) provide affordable and quality child care that is a lifeline for working families, which is critical to building a stronger economy, workforce, and communities;

(7) address the climate crisis by transitioning to renewable energy, promoting environmental justice, and conserving public and wild lands, which is essential to building resilient communities and a sustainable future;

(8) reduce gun violence through common-sense gun safety reform, which will protect families from senseless gun violence, which is critical to creating safer communities;

(9) build a tax code that works for working families and small businesses, and ensure the wealthy pay their fair share, which is essential in order to invest in critical resources such as housing and mental health care; and

(10) encourage States, counties, and local municipalities to develop policies that have a focus on connection and social connectivity.

The Secretary of Health and Human Services (in this section referred to as the Secretary), in consultation with the appropriate Federal officials, shall establish a program to award grants, on a competitive basis, to State or local governments to support eligible entities to create and scale community connection programs and local institutions that bring people together at community facilities.

To be eligible to receive a grant under this section, a State or local government shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

A grant awarded under this section—

(1) may be used to pay the salary or wages of appropriate staff of the community connection programs and local institutions referred to in subsection (a); and

(2) may not be used for the construction of any facility.

In awarding grants under this section, the Secretary shall prioritize—

(1) underserved communities; and

(2) communities with high percentages of children or elderly individuals.

In this section:

The term appropriate Federal officials means—

(A) the Administrator of the Administration for Community Living;

(B) the Secretary of Education;

(C) the Secretary of Veterans Affairs;

(D) the Secretary of Labor; and

(E) the Director of the Institute of Museum and Library Services.

The term eligible entity means a governmental or nonprofit entity that is—

(A) a library;

(B) a senior center;

(C) a childcare center or after-school program;

(D) a recreation center;

(E) a teen center;

(F) a veteran service organization; or

(G) any other entity, as the relevant State or local government determines appropriate.

There is authorized to be appropriated to carry out this section $200,000,000 for each of fiscal years 2025 through 2029.

The Secretary of Housing and Urban Development (in this section referred to as the Secretary) shall establish a competitive grant program to award grants to eligible entities to plan and build infrastructure that encourages social connection.

To be eligible for a grant under this section, an entity shall be—

(1) a State government;

(2) a local government;

(3) a metropolitan planning organization; or

(4) a multijurisdictional group of entities described in paragraphs (1) through (3).

An eligible entity may use amounts awarded under this section to—

(1) plan infrastructure projects that encourage social connection, including—

(A) parks;

(B) playgrounds;

(C) recreation spaces; and

(D) access to natural areas;

(2) build such projects; and

(3) preserve such projects.

The Secretary shall give preference to eligible entities that—

(1) demonstrate environmentally conscious operations;

(2) emphasize accessibility for disabled individuals; or

(3) are located in or represent underserved communities.

There are authorized to be appropriated to the Secretary to carry out this section $170,000,000 for each of fiscal years 2025 through 2029.

The Secretary of Health and Human Services (in this section referred to as the Secretary) shall establish a program to make grants, on a competitive basis, to covered entities for the purposes described in subsection (c).

To be eligible to receive a grant under this section, a covered entity shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require.

The purposes described in this subsection are the following:

(1) To conduct outreach, through established screening tools or other methods, as the Secretary determines appropriate, to at-risk individuals regarding the health effects of loneliness and social isolation.

(2) To develop and implement community-based interventions for the purpose of mitigating loneliness or social isolation in at-risk individuals, including evidence-based programs, as determined by the Secretary, developed with multi-stakeholder input.

(3) To connect at-risk individuals with community social or clinical support.

In this section:

The term at-risk individual means an individual who—

(A) is—

(i) between the ages of 18 and 25 years old; or

(ii) 60 years of age or older;

(B) has a disability;

(C) has a pre-existing health condition; or

(D) has poor indicators of social determinants of health, which may include—

(i) the conditions in which people are born, grow, work, live, worship, and age; and

(ii) a wide set of forces and systems that shape daily life, such as economic policies and systems.

The term covered entity means—

(A) an area agency on aging;

(B) a center for independent living; and

(C) such other community-based organization, as the Secretary determines appropriate.

There is authorized to be appropriated such sums as may be necessary to carry out this section.

The Secretary of Health and Human Services, acting through the Assistant Secretary for Mental Health and Substance Use, (in this section referred to as the Secretary) shall establish a demonstration program to award grants to States and localities to support eligible organizations in—

(1) coordinating group therapy care for mental health and substance use treatment;

(2) administrative and operational costs related to such treatment; and

(3) outreach, participant recruitment, patient education, and treatment plan development.

In awarding grants under this section, the Secretary shall give priority to States and localities that will support eligible organizations in rural areas.

The Secretary shall provide technical assistance to States and localities seeking or receiving a grant under this section.

In this section, the term eligible organization means a partnership between—

(1) at least 1—

(A) clinician with a private practice;

(B) health care center or association of community health centers; or

(C) hospital; and

(2) at least 1—

(A) elementary or secondary school;

(B) institution of higher education; or

(C) community organization, including a senior center, youth center, or LGBTQ center.

Section 547(f) of the Public Health Service Act (42 U.S.C. 290ee–2(f)) is amended by striking $5,000,000 for each of fiscal years 2019 through 2023 and inserting $16,000,000 for each of fiscal years 2025 through 2029.

Part F of title VII of the Public Health Service Act (42 U.S.C. 295h) is amended—

(1) by amending the part heading to read as follows: Substance use disorder treatment and mental health workforce loan repayment programs;

(2) in section 781(e)(2), by striking 338I, or 846 and inserting 338I, 782, or 846; and

(3) by adding at the end the following:

The Secretary, acting through the Administrator of the Health Resources and Services Administration, (in this section referred to as the Secretary) shall carry out a program under which—

(1) the Secretary enters into agreements with individuals to make payments in accordance with subsection (b) on the principal of and interest on any eligible loan; and

(2) the individuals each agree to the requirements of service in mental health services employment, as described in subsection (d).

For each year of obligated service by an individual pursuant to an agreement under subsection (a), the Secretary shall make a payment to such individual as follows:

The Secretary shall pay—

(A) for each year of obligated service by an individual pursuant to an agreement under subsection (a), 1/6 of the principal of and interest on each eligible loan of the individual which is outstanding on the date the individual began service pursuant to the agreement; and

(B) for completion of the sixth and final year of such service, the remainder of such principal and interest.

The total amount of payments under this section to any individual shall not exceed $75,000.

The loans eligible for repayment under this section are each of the following:

(1) Any loan for education or training for a substance use disorder treatment employment.

(2) Any loan under part E of title VIII (relating to nursing student loans).

(3) Any Federal Direct Stafford Loan, Federal Direct PLUS Loan, Federal Direct Unsubsidized Stafford Loan, or Federal Direct Consolidation Loan (as such terms are used in section 455 of the Higher Education Act of 1965).

(4) Any Federal Perkins Loan under part E of title I of the Higher Education Act of 1965.

(5) Any other Federal loan as determined appropriate by the Secretary.

Any individual receiving payments under this program as required by an agreement under subsection (a) shall agree to an annual commitment to full-time employment, with no more than 1 year passing between any 2 years of covered employment, in mental health services employment in the United States in a Mental Health Professional Shortage Area, as designated under section 332.

No borrower may, for the same service, receive a reduction of loan obligations or a loan repayment under both—

(1) this section; and

(2) any federally supported loan forgiveness program, including under section 338B, 338I, 781, or 846 of this Act, or section 428J, 428L, 455(m), or 460 of the Higher Education Act of 1965.

The Secretary may establish a liquidated damages formula to be used in the event of a breach of an agreement entered into under subsection (a).

The failure by an individual to complete the full period of service obligated pursuant to such an agreement, taken alone, shall not constitute a breach of the agreement, so long as the individual completed in good faith the years of service for which payments were made to the individual under this section.

The Secretary—

(1) may establish such criteria and rules to carry out this section as the Secretary determines are needed and in addition to the criteria and rules specified in this section; and

(2) shall give notice to the committees specified in subsection (h) of any criteria and rules so established.

Not later than 5 years after the date of enactment of this section, and every other year thereafter, the Secretary shall prepare and submit to the Committee on Energy and Commerce of the House of Representatives and the Committee on Health, Education, Labor, and Pensions of the Senate a report on—

(1) the number and location of borrowers who have qualified for loan repayments under this section; and

(2) the impact of this section on the availability of substance use disorder treatment employees nationally and in shortage areas and counties described in subsection (d).

In this section:

The term community-based organization includes, except as otherwise provided by the Secretary, a nonprofit community-based organization, a consortium of nonprofit community-based organizations, a national nonprofit organization acting as an intermediary for a community-based organization, or a community-based organization that has a fiscal sponsor that allows the organization to function as an organization described in section 501(c)(3) of the Internal Revenue Code of 1986 and exempt from taxation under section 501(a) of such Code.

The terms Indian tribe and tribal organization have the meanings given those terms in section 4 of the Indian Self-Determination and Education Assistance Act.

The term mental health services employment means full-time employment (including a fellowship)—

(A) where the primary intent and function of the position is the direct treatment or recovery support of patients with or in recovery from a diagnosable mental, behavioral, or emotional disorder, including master’s level social workers, psychologists, counselors, marriage and family therapists, psychiatric mental health practitioners, child and adolescent psychiatrists, occupational therapists, psychology doctoral interns, behavioral health paraprofessionals and physicians, physician assistants, and nurses, who are licensed or certified in accordance with applicable State and Federal laws; and

(B) which is located at a mental health treatment program, private physician practice, hospital or health system-affiliated inpatient treatment center or outpatient clinic (including an academic medical center-affiliated treatment program), correctional facility or program, youth detention center or program, inpatient psychiatric facility, crisis stabilization unit, community health center, community mental health or other specialty community behavioral health center, recovery center, school, community-based organization, telehealth platform, migrant health center, health program or facility operated by an Indian tribe or tribal organization, Federal medical facility, or any other facility as determined appropriate for purposes of this section by the Secretary.

The term municipality means a city, town, or other public body created by or pursuant to State law, or an Indian tribe.

Section 2703 of the American Rescue Plan Act of 2021 (Public Law 117–2; 135 Stat. 46) is amended—

(1) in subsection (b), by striking appropriated by subsection (a) and inserting appropriated by subsection (a) or pursuant to subsection (c); and

(2) by adding at the end the following:

There is authorized to be appropriated for the purpose described in subsection (b) $100,000,000 for the period of fiscal years 2025 through 2029.

Section 2704 of the American Rescue Plan Act of 2021 (Public Law 117–2; 135 Stat. 46) is amended—

(1) in subsection (b), by striking appropriated by subsection (a) and inserting appropriated by subsection (a) or pursuant to subsection (c); and

(2) by adding at the end the following:

There is authorized to be appropriated for the purpose described in subsection (b) $100,000,000 for the period of fiscal years 2025 through 2029.

Section 2705 of the American Rescue Plan Act of 2021 (Public Law 117–2; 135 Stat. 46) is amended—

(1) in subsection (b), by striking appropriated by subsection (a) and inserting appropriated by subsection (a) or pursuant to subsection (c); and

(2) by adding at the end the following:

There is authorized to be appropriated for the purpose described in subsection (b) $100,000,000 for the period of fiscal years 2025 through 2029.

The Secretary of Health and Human Services, acting through the Administrator of the Health Resources and Services Administration, (in this section referred to as the Secretary) shall establish a task force to prevent health care worker burnout (in this section referred to as the Task Force).

The Task Force shall have the following members, to be appointed by the Secretary (unless otherwise specified):

(1) The Surgeon General, who shall serve as chair.

(2) A representative from the Centers for Medicare & Medicaid Services.

(3) A representative from the Centers for Disease Control and Prevention.

(4) A representative from the Office of Rural Health Policy of the Health Resources and Services Administration.

(5) A representative from the Provider Relief Bureau of the Health Resources and Services Administration.

(6) A representative from the Office of Civil Rights, Diversity, and Inclusion of the Health Resources and Services Administration.

(7) Such other members as the chair determines appropriate, who shall be appointed by the chair.

Not later than 2 years after the date of enactment of this Act, the Task Force shall submit to Congress a report that includes—

(1) statistics and data on turnover in health care employment and health care worker satisfaction (including with regard to the mental health and substance use disorder workforces);

(2) recommendations on how to reduce burnout among health care workers;

(3) an assessment of burnout in Health Resources and Services Administration workforce programs and how such programs may be improved; and

(4) a study of the administrative burden of health insurance systems (including Medicare, Medicaid, CHIP programs, and VA health).

Section 102(14)(N) of the Older Americans Act of 1965 (42 U.S.C. 3002(14)(N)) is amended by inserting or loneliness after social isolation each place it appears.

The Secretary of Health and Human Services shall establish within the Department of Health and Human Services a working group to formulate recommendations for standardizing the methods by which agencies and components of the Department measure loneliness and isolation.

The Comptroller General of the United States shall conduct a study on the impact of social isolation and efforts by the Federal Government and State and local governments to address such social isolation.

Not later than 5 years after the date of enactment of this Act, the Comptroller General of the United shall submit to Congress a report detailing the results of the study under subsection (a).

Section 1861 of the Social Security Act (42 U.S.C. 1395x) is amended—

(A) in subsection (s)(2), by adding at the end the following new subparagraphs:

(KK) professional services furnished by a community health worker (as defined in subsection (nnn)) on or after October 1, 2026;

(LL) certified community behavioral health clinic services (as defined in section 1905(jj)) furnished on or after October 1, 2026;

(A) ; and

(B) by adding at the end the following new subsection:

The term community health worker means an individual who is a frontline health worker who is a trusted member of the community in which the worker serves or who has an unusually close understanding of the community served that enables the worker to build trusted relationships, serve as a liaison or link between health and social services and the community, facilitate access to services, improve the quality and cultural competence of service delivery, build individual and community capacity, and increase health knowledge and self-sufficiency through a wide range of community health worker core roles, including through—

(1) providing cultural mediation among individuals, communities, and health and social service systems;

(2) providing culturally appropriate health education and information;

(3) providing care coordination, case management, and system navigation;

(4) providing coaching and social support;

(5) advocating for individuals and communities;

(6) building individual and community capacity;

(7) providing direct service, including basic screening tests, such as weight and blood pressure screening, basic services such as diabetic foot checks, and meeting basic needs;

(8) implementing individual and community assessments;

(9) conducting outreach; and

(10) participating in evaluation and research

Section 1833 of the Social Security Act (42 U.S.C. 1395l) is amended—

(A) in subsection (a)(1)—

(i) in subparagraph (GG), by striking and at the end; and

(ii) by inserting before the semicolon at the end the following:, and (II) with respect to professional services furnished by a community health worker (as defined in section 1861(nnn)) and certified community behavioral health clinic services (as defined in section 1905(jj)), the amounts paid shall be 100 percent of the lesser of the actual charge for the services or the amount determined under a fee schedule established by the Secretary for such services; and

(B) in subsection (b)—

(i) by striking, and (13) and inserting (13); and

(ii) by striking 1861(n). and inserting 1861(n), (14) such deductible shall not apply with respect to professional services furnished by a community health worker (as defined in section 1861(nnn)), and (15) such deductible shall not apply with respect to certified community behavioral health clinic services (as defined in section 1905(jj)).

Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended—

(A) in paragraph (31), by striking and at the end;

(B) by redesignating paragraph (32) as paragraph (33); and

(C) by inserting after paragraph (31) the following new paragraph:

(32) beginning on October 1, 2026, professional services furnished by a community health worker (as defined in section 1861(nnn)); and

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended—

(A) in subsection (b), by striking and (ii) and inserting (ii), and (kk); and

(B) by adding at the end the following new subsection:

For each fiscal quarter beginning on or after October 1, 2026, the Federal medical assistance percentage for a State shall be increased by 6 percentage points with respect to amounts expended by the State for medical assistance for professional services furnished by a community health worker (as defined in section 1861(nnn)).

Section 338B of the Public Health Service Act (42 U.S.C. 254l–1) is amended—

(1) in subsection (b)(1)(A), by striking or physician assistant and inserting physician assistant, or community health worker; and

(2) by adding at the end the following:

In this section, the term community health worker means an individual who—

(1) promotes wellness by helping individuals adopt healthy behaviors;

(2) implements programs and advocates for individuals who may have limited access to health resources and social services; and

(3) works closely with other health care and social service providers.

Section 11003(b) of the Bipartisan Safer Communities Act (42 U.S.C. 1396a note) is amended by inserting, and $50,000,000 for fiscal year 2026, after fiscal year 2022.

Part D of title V of the Public Health Service Act (42 U.S.C. 290dd et seq.) is amended by adding at the end the following:

The Secretary, acting through the Assistant Secretary for Mental Health and Substance Use, (in this section referred to as the Secretary) shall establish the Project Advancing Wellness and Resiliency in Education (in this section referred to as Project AWARE), to award grants to develop a sustainable infrastructure for school-based mental health programs and services.

A grant awarded under Project AWARE may be used to provide peer mental health first aid training, including—

(1) to train teachers, other relevant school personnel (including education support professionals), students, and parents and caregivers of students—

(A) to recognize symptoms of childhood and adolescent mental health conditions;

(B) to refer teachers, school personnel, students, and their family members to appropriate mental health services if necessary; and

(C) to recognize signs of immediate mental distress and, upon recognizing such signs apply mental health first aid tactics; and

(2) to provide education to such teachers, personnel, students, parents, and caregivers regarding resources that are available in the community for individuals with a mental illness.

There is authorized to be appropriated to carry out this section $130,000,000 for each of fiscal years 2026 through 2030.

Section 4201(a)(2) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7171(a)(2)) is amended by inserting mental health services, community service activities, after counseling programs,.

Section 4206 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7176) is amended to read as follows:

There are authorized to be appropriated to carry out this part—

(1) $1,329,673,000 for fiscal year 2025;

(2) $1,429,673,000 for fiscal year 2026;

(3) $1,529,673,000 for fiscal year 2027;

(4) $1,629,673,000 for fiscal year 2028; and

(5) $1,729,673,000 for fiscal year 2029.

Section 4601 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7251(a)) is amended—

(1) in the matter preceding paragraph (1) of subsection (a), by inserting (except for section 4625) after part;

(2) in the matter preceding clause (i) of subsection (b)(2)(B), by inserting (except for section 4625) after subpart 2; and

(3) by adding at the end the following:

There are authorized to be appropriated to carry out section 4625—

(1) $500,000,000 for fiscal year 2025;

(2) $600,000,000 for fiscal year 2026;

(3) $700,000,000 for fiscal year 2027;

(4) $850,000,000 for fiscal year 2028; and

(5) $1,000,000,000 for fiscal year 2029.

Section 4623(a) of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7273(a)) is amended—

(1) by redesignating paragraph (2) as paragraph (3); and

(2) by striking paragraph (1) and inserting the following:

The Secretary shall use not less than 95 percent of the amounts made available under section 4601(b)(2)(B) to award grants, on a competitive basis and subject to subsection (e), to eligible entities for the implementation of a comprehensive, effective continuum of coordinated services that meets the purpose described in section 4621(1) by carrying out activities in neighborhoods with—

(A) high concentrations of low-income individuals;

(B) multiple signs of distress, which may include high rates of poverty, childhood obesity, academic failure, and juvenile delinquency, adjudication, or incarceration; and

(C) schools implementing comprehensive support and improvement activities or targeted support and improvement activities under section 1111(d).

The Secretary shall use the amounts made available under section 4601(c) to carry out the full-service community school program under section 4625.

In this Act:

The term burnout means exhaustion and mental distance from one’s job.

The term loneliness means subjectively feeling alone, or the discrepancy between one’s desired level of social connection and one’s actual level of social connection.

The term social connection means the variety of ways one can connect with others socially, through physical, behavioral, social-cognitive, and emotional channels.

The term social isolation means objectively being alone, or having few relationships or infrequent social contact.

The term underserved communities includes communities with a high proportion of individuals who—

(A) are socioeconomically disadvantaged;

(B) have limited English proficiency;

(C) are geographically isolated;

(D) are educationally disenfranchised;

(E) are individuals of color;

(F) are of ethnic or national origin minorities;

(G) are women or children;

(H) have disabilities; or

(I) are seniors.