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.
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The HCBS Access Act requires all state Medicaid programs to cover home and community-based services for people with disabilities and older adults, eliminating the need for states to apply for special waivers. The federal government would pay 100% of the costs for these services, which include personal care, nursing, transportation, housing support, and assistive technology.
Who Benefits and How
People with disabilities and older adults benefit by gaining guaranteed access to services that allow them to live in their communities rather than institutions, with waiting lists eliminated. Direct care workers (home health aides, personal care attendants) benefit from requirements for living wages and workforce development programs. Family caregivers benefit from respite care and support services. States benefit from 100% federal funding for HCBS.
Who Bears the Burden and How
The federal government bears significantly increased costs (100% FMAP for HCBS). States must develop implementation plans, meet new reporting requirements, and ensure adequate provider payments. Healthcare providers must meet new quality metrics and reporting standards.
Key Provisions
- Mandates HCBS coverage under Medicaid with eligibility based on functional impairment (2+ ADL/IADL limitations)
- Provides 100% federal matching for HCBS costs
- Expands Medicaid eligibility to 150% of poverty or 300% of SSI for HCBS-eligible individuals
- Requires states to address workforce issues including living wages for direct care workers
- Sunsets existing Section 1915 HCBS waivers after 5 years
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Mandates comprehensive home and community-based services (HCBS) coverage under Medicaid with 100% federal funding to eliminate waiting lists and support people with disabilities and older adults living in their communities
Key Policy Areas
Healthcare, Disability Rights, Medicaid, Labor, Social Services
Primary Purpose
Mandates comprehensive home and community-based services (HCBS) coverage under Medicaid with 100% federal funding to eliminate waiting lists and support people with disabilities and older adults living in their communities
Policy Domains
Title I - Medicaid Home and Community-Based Services
Identified Gains
Contextual inference, no direct clause citation- People with disabilities
- Older adults
- Direct care workers
- Family caregivers
- States
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- Federal government
- State Medicaid agencies
- Healthcare providers
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
IntroducedMr. Casey (for himself, Ms. Hassan, Mr. Brown, Mr. Kaine, …
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Direct care professionals, Direct care workers, Direct care workforce
Positive-direction: Direct care professionals, Direct care workers, Direct care workforce, Direct care workforce programs, Direct support professionals, Family caregivers, Home care agencies, Home care service providers
Negative-direction: HCBS providers
HCBS recipients, Married couples with one member needing HCBS, Moderate-income individuals needing HCBS
Community colleges, Community colleges and training providers, Direct care workforce training programs
Positive-direction: Community colleges, Community colleges and training providers, Direct care workforce training programs, Training and education providers, Workforce training organizations
Negative-direction: Grant applicant organizations, Grant recipient organizations
State Medicaid agencies, State Medicaid programs
Positive-direction: State Medicaid agencies
Negative-direction: State Medicaid programs
Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Department of Health and Human Services
Positive-direction: Labor statisticians and workforce planners
Negative-direction: Agency for Healthcare Research and Quality, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Office of Management and Budget
HCBS policy researchers, National Academy of Medicine
Nursing homes and institutional facilities
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_director"
- → Director of Agency for Healthcare Research and Quality
- "the_secretary"
- → Secretary of Health and Human Services
- "the_administrator"
- → Administrator of Centers for Medicare and Medicaid Services
Key Definitions
Terms defined in this bill
Information relating to races, ethnicities, genders, sexual orientations, gender identities, geographic locations, incomes, primary languages, types of service setting, and disability types represented within a particular group
Services furnished to eligible individuals based on individualized assessment in a community setting, including personal assistance, supported employment, respite, case management, housing support, and more
An individual with a functional impairment expected to last at least 90 days, or currently receiving HCBS under existing waivers, or under age 21 and eligible under the State plan
Inability to perform without assistance: 2+ activities of daily living, 2+ instrumental activities of daily living, or 1 of each
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology