New HCBS Bill Demands States Report Wait Times and Service Delivery Rates Annually

The “Helping Communities with Better Support Act” is all about home and community-based services (HCBS)—the support that allows people with disabilities and the elderly to live at home rather than in an institution. This bill tries to do two big things: open the door to more people needing care and force states to be far more honest about how long people wait for help and how much service they actually get.

The Open Door, With a Catch

Right now, getting HCBS through Medicaid waivers is complicated. You usually have to pass strict eligibility tests. This bill offers states a potential shortcut: they could get a waiver to cover people who meet the broader disability definitions found in the Americans with Disabilities Act (ADA) or the Rehabilitation Act, even if they haven’t gone through the typical lengthy Medicaid eligibility process (Section 2). This is a big deal because it could potentially bring services to many people who need support but fall into the gap between traditional Medicaid rules and real-life needs.

However, this isn’t a free pass. If a state wants this flexibility, they have to prove to the federal government that adding these new people will not make the wait times longer for everyone already in the system or on the existing waiting lists. Think of it like this: the state has to show their current service pipeline can handle the new flow without causing a bigger traffic jam for current recipients. They also have to ensure all their existing HCBS waivers are already fully compliant with federal rules before they can even apply for this new authority. For states currently struggling with compliance, this new flexibility is off the table until they clean up their act.

Where the Rubber Meets the Road: Transparency

Perhaps the most impactful part of this bill for everyday people is the massive increase in required transparency (Section 2). If you or a loved one is waiting for HCBS, you know how frustrating the black box of waiting lists can be. This bill mandates annual reporting from states detailing exactly how they manage their waiting lists. They have to report how many people are waiting, how often they check if those people are still eligible, and, crucially, the average time people who were approved actually spent waiting.

States must also report on service delivery itself. They have to track the average time between when services are approved and when the person actually starts getting them. Even more specific, they must report the average percentage of authorized service hours that were actually delivered over the past year. If your care plan authorizes 20 hours of personal care a week, but the state only manages to deliver 15 hours due to staffing shortages, that gap is now public data. This level of detail—especially for critical services like homemaker, home health aide, and personal care—gives families and advocates the hard data they need to hold state agencies accountable for promised care.

Bridging the Gap in Coverage

Finally, the bill addresses a common frustration: the gap between being found eligible for care and actually starting to receive services. The Secretary of Health and Human Services must issue guidance by January 1, 2026, on how states can offer up to 60 days of interim coverage immediately after eligibility is determined, even before the full, formal care plan is finalized (Section 2). For a family juggling work and caregiving, those two months of immediate, temporary support can be the difference between stability and crisis while they wait for the paperwork to be finalized.