What does Preamble of HCBS Access Act do?

This bill, formally titled 'To amend title XIX of the Social Security Act to require coverage of, and expand access to, home and community-based services under the Medicaid program; to award grants for the creation, recruitment, training and education, retention, and advancement of the direct care workforce and to award grants to support family caregivers; and for other purposes,' aims to modify the Social Security Act. The bill intends to require coverage of, and expand access to, home and community-based services under the Medicaid program. It proposes awarding grants for workforce development within the direct care sector, encompassing creation, recruitment, training, education, retention, and advancement. The bill also includes provisions for granting support to family caregivers.

What does DEFINITIONS. of HCBS Access Act do?

This section defines key terms used within the Act. “Demographics” is defined as information relating to various characteristics of individuals, including race, ethnicity, gender, sexual orientation, and income. “Private duty nursing” refers to individualized and continuous nursing care exceeding what's typically available from visiting nurses or hospital staff, provided in an individual's home. “Secretary” generally refers to the Secretary of Health and Human Services.

What does PURPOSE. of HCBS Access Act do?

This title aims to require coverage of home and community-based services (HCBS) under State Medicaid plans or waivers. A primary goal is to eliminate waiting lists for HCBS, improving access to services and community inclusion for people with disabilities and older adults. The legislation seeks to build upon existing HCBS programs and fulfill the Medicaid program's purpose of providing medical assistance and long-term supports. It intends to ensure access to HCBS for individuals with various disabilities, including intellectual, cognitive, developmental, behavioral health, physical, and substance use disorders, as well as older adults. The bill aims to streamline HCBS access by reducing the need for repeated state waiver applications. It seeks to increase the capacity of community services and prevent unnecessary institutionalization. The legislation recognizes research indicating that individuals with even severe disabilities can live in the community with appropriate support. The bill addresses disparities in accessing HCBS based on race, gender, sexual orientation, and gender identity. It intends to support unpaid family caregivers by addressing service gaps, workforce shortages, and inefficiencies. The legislation aims to improve direct care quality and workforce standards for direct care workers.

What does REQUIRING COVERAGE OF HOME AND COMMUNITY-BASED SERVICES UNDER of HCBS Access Act do?

This section amends the Social Security Act to define 'home and community-based services' for purposes of the Medicaid program. The definition includes a wide range of services such as supported employment, personal assistance, transportation, respite services, and caregiver support. A panel will be established to recommend additional services for inclusion as home and community-based services, with a majority of members selected from categories representing individuals with disabilities, beneficiary-led disability rights organizations, and disability-led organizations. The Secretary must consider public comment and data on coverage gaps when identifying additional services. States are required to establish programs to support self-directed care models, including registering direct care workers and facilitating beneficiary hiring of caregivers. Certain administrative costs related to expanding and enhancing home and community-based services will have an 80% federal matching rate for a specified period.

What does MEDICAID ELIGIBILITY MODIFICATIONS. of HCBS Access Act do?

This section amends Section 1902 of the Social Security Act, impacting Medicaid eligibility. It modifies subparagraph (A)(i) of paragraph (10) to add a new subclause (X) for eligible individuals with income not exceeding 150% of the poverty line or 300% of the supplemental security income benefit rate, beginning five years after enactment or a state-elected earlier date. It also modifies subparagraph (A)(ii) of paragraph (10) to add a new subclause (XXIV) for individuals whose income exceeds the levels in subclause (X) but is below a state-established level. Paragraph (34) of subsection (a) is amended to clarify the availability of medical assistance for care and services provided before an individual's eligibility determination. Subsection (xx)(9)(A)(ii) is modified by adding a new subclause (X) referencing subclauses (X) of subsection (a)(10)(A)(i) and (XXIV) of subsection (a)(10)(A)(ii).

What does HOME AND COMMUNITY-BASED SERVICES IMPLEMENTATION PLAN. of HCBS Access Act do?

This section amends Section 1902 of the Social Security Act to require states to submit an implementation plan to the Secretary. The implementation plan must detail how the state will operationalize eligibility determinations, describe the direct care workforce, and list existing home and community-based services. The plan must also outline outreach and education activities, coordination with other state agencies, and a process for consulting with Indian tribes where applicable. States must describe how they will build capacity, prioritize individuals on waiting lists, and coordinate eligibility with other disability programs. The plan requires data and milestone requirements to ensure community integration and address disparities. Section 1903(a) of the Social Security Act is amended to provide a 100% federal medical assistance percentage (FMAP) for costs associated with developing the implementation plan.

What does QUALITY OF SERVICES. of HCBS Access Act do?

This section requires the Secretary of Health and Human Services to develop standardized, State-level metrics for access to and satisfaction with healthcare providers for individuals enrolled in State Medicaid plans. These metrics must be developed within one year of the Act's enactment and will be broken down by demographics and other categories determined by the Secretary. The metrics will include data on individuals requiring care in specific institutional settings, such as nursing facilities and institutions for mental disease. The metric development process must be public and allow for stakeholder participation. The Secretary is required to update these metrics at least once every three years. The Secretary may award funds to States to help implement the metrics. An appropriation of $200,000,000 is provided for fiscal year 2026 to carry out this section.

What does REPORTS; TECHNICAL ASSISTANCE; OTHER ADMINISTRATIVE of HCBS Access Act do?

This section outlines reporting requirements for the Secretary regarding the HCBS implementation plan grant program. The Secretary must submit interim, first implementation, and subsequent reports to several Congressional committees. The first implementation report requires a description of approved HCBS implementation plans and a national landscape assessment of gaps, disparities, and barriers in home and community-based services. Subsequent reports will detail the number of HCBS program improvement States, progress made, outcomes related to quality measures, and challenges/best practices reported by States. The Secretary is required to provide technical assistance to HCBS program improvement States and issue guidance or regulations as needed. The Secretary, in coordination with the Secretary of Labor and the Administrator of the Centers for Medicare & Medicaid Services, must issue recommendations to strengthen the direct care workforce. These recommendations must be informed by stakeholder consultation, including recipients, family caregivers, providers, direct care workers, and advocates. The section appropriates $10,000,000 for fiscal year 2026 to the Secretary for carrying out this section, with funds remaining available until expended.

What does QUALITY MEASUREMENT AND IMPROVEMENT. of HCBS Access Act do?

This section establishes requirements for the development and publication of core and supplemental sets of home and community-based services (HCBS) quality measures. The Secretary is required to review and update these measures at least once every year. Development of the measures must involve collaboration with subagency heads and input from stakeholders, including recipients, family caregivers, providers, and advocates, with at least half of the input coming from current or potential recipients and family caregivers. The measures must reflect a full array of HCBS and recipients, including adults and children, and must include outcomes-based measures, measures of service availability, provider capacity, person-centered care, self-directed care, transitions to institutional care, beneficiary and family caregiver surveys, and measures related to health disparities. The section allows for the collection of data disaggregated by demographics. The section appropriates $10,000,000 for fiscal year 2026 to carry out these activities. State Medicaid programs must use the published quality measures (or approved alternatives) to report information to the Secretary within two years and annually thereafter. States must make the reported information publicly available. The Social Security Act is amended to provide an increased federal matching rate for states reporting HCBS quality information. Each state must establish an HCBS ombudsman office that operates independently, provides assistance to beneficiaries and families, and reports systemic problems.

What does MAKING PERMANENT THE STATE OPTION TO EXTEND PROTECTION UNDER of HCBS Access Act do?

This section amends Section 1924(h)(1)(A) of the Social Security Act to modify the definition of an eligible individual for Medicaid protection against spousal impoverishment. The amendment strikes the reference to 'section 1902(a)(10)(A)(ii)(VI)' and inserts the reference to 'section 1905(ll)(3)' within Section 1924(h)(1)(A). This section also amends Section 2404 of the Patient Protection and Affordable Care Act. The amendment to Section 2404 removes the expiration date of 'September 30, 2027' and replaces it with 'the date of enactment of the HCBS Access Act'.

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HCBS Access Act

Last updated: 4/28/2026 · Introduced: 4/28/2026

Author: Debbie Dingell (D-MI)

TL;DR (AI)

The bill requires states to cover a wider range of home and community-based services (HCBS) under Medicaid, aiming to eliminate waiting lists and improve access for individuals with disabilities and older adults.
It establishes a grant program to support the recruitment, training, retention, and advancement of direct care workers and provide assistance to family caregivers.
The bill modifies Medicaid eligibility criteria to expand coverage to individuals with varying income levels, potentially increasing access to services.
States are required to develop and implement plans to improve HCBS quality, including standardized metrics and data collection disaggregated by demographics.
The legislation directs the Office of Management and Budget to consider creating a separate occupational code for direct support professionals to better understand workforce shortages and improve data collection.

119th Congressin committeeHR. 6951(In Committee)Official page

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