The HCBS Access Act mandates home and community-based services as a core Medicaid benefit while providing significant federal funding to expand access, strengthen the direct care workforce, and support family caregivers.
Ben Luján
Senator
NM
The HCBS Access Act transforms home and community-based services into a mandatory Medicaid benefit, ensuring older adults and people with disabilities can receive long-term care in their own homes rather than institutions. The legislation provides significant federal funding to eliminate waiting lists, strengthen the direct care workforce, and offer critical support to unpaid family caregivers. Additionally, it establishes new national standards for workforce data, career development, and program evaluation to ensure high-quality, accessible care nationwide.
HCBS Access Act Mandates Medicaid Home Care Coverage: 100% Federal Match for States to End Waiting Lists
Right now, if you or a loved one needs long-term care, Medicaid is only required to pay for a nursing home. If you want to stay in your own house, you’re often stuck on a years-long waiting list for an 'optional' state waiver. This bill flips the script by making Home and Community-Based Services (HCBS) a mandatory Medicaid benefit starting five years after it passes. It covers everything from personal care and private nursing to home modifications and respite for family caregivers. To get states on board, the federal government is offering a massive carrot: a 100% matching rate for these services if states play ball by removing barriers to care and boosting worker pay (Title I).
Moving Care to the Living Room
The core of this bill is about keeping people in their own neighborhoods rather than institutions. It defines eligibility based on a 'functional impairment' expected to last at least 90 days, determined by an individualized assessment. For a family caring for an aging parent or a child with a disability, this means access to professional help with daily tasks, nutrition services, and even housing support. The bill also permanently protects the 'spousal impoverishment' rules, ensuring that if one spouse needs expensive home care, the other isn't forced into poverty just to qualify for Medicaid (Title I).
Respect for the Frontline
If you’ve ever tried to hire a home health aide, you know the industry is struggling. This bill tackles the workforce crisis by directing the government to finally give 'Direct Support Professionals' their own official job code, which helps track labor shortages and turnover more accurately (Title II). It also puts $1 billion on the table for grants in 2029 to fund training and career ladders. For workers, this could mean better wages tied to skill gains; for families, it means less turnover and more reliable care from people who are actually trained for the job (Title III).
The Fine Print on Implementation
While the bill offers a lot of federal cash, it asks for a lot of data in return. States will have to submit massive implementation plans detailing how they’ll fix workforce shortages and coordinate with housing and transportation agencies. There’s also a new requirement for a national survey within seven years to see if the law is actually working. One thing to watch: the bill uses a very broad definition of 'demographics' for data collection, including everything from gender identity to geographic location. While that helps identify who isn't getting care, it also means a lot more personal data moving through state systems (SEC. 2, Title IV).