Medicaid Act Lets States Skip Federal Review on Home Care Waivers: What the Longer Cycles Mean for Services

The Medicaid Empowerment Act of 2025 is short, but it makes a significant administrative change to how states manage crucial healthcare programs. Specifically, it updates Section 1915 of the Social Security Act to allow states to have renewal periods longer than five years for certain Home and Community-Based Services (HCBS) waivers.

The Administrative Efficiency Trade-Off

Think of HCBS waivers as the programs that allow people—like seniors or those with disabilities—to receive necessary care at home or in their community, rather than in an institution. These services are vital for keeping people employed, independent, and close to family. Currently, states must regularly renew these complex programs with the federal government, generally every five years, which involves a massive review process. This bill aims to reduce that administrative churn, giving state Medicaid agencies more stability and less paperwork. For state administrators, this is a clear win: they can plan for longer periods without the headache of constant federal review.

Stability vs. Oversight: What It Means for Care

While reduced bureaucracy sounds great on paper, this change introduces a classic policy trade-off: stability versus oversight. Extending the maximum renewal period means the federal Centers for Medicare & Medicaid Services (CMS) will review these programs less frequently. For a person receiving these services—say, a retired construction worker relying on a home health aide—this could mean greater continuity if the state agency is more stable. However, if the state’s program is underperforming or needs updating to reflect new best practices, that problem could persist for an extra few years before the mandatory federal review catches it.

The Real-World Impact of Less Frequent Reviews

Advocacy groups and beneficiaries often use the mandatory five-year renewal period as a critical pressure point to push for needed improvements, better reimbursement rates for caregivers, or expanded eligibility. By stretching out the renewal cycle, the bill reduces the frequency of this formal federal check-in. If a state’s waiver rules are outdated—perhaps the hourly rate paid to direct care workers is too low, leading to high turnover—it might take longer to force that state to address the issue. This is a concern because the quality of HCBS programs is highly dependent on timely adjustments and strong quality assurance measures. The question now becomes whether states will step up their internal quality monitoring to compensate for the reduced frequency of federal scrutiny.