Sponsors (15)
Official title: 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.
Introduced April 28, 2026 by Debbie Dingell · Last progress April 28, 2026
The bill aims to expand and improve home- and community-based services and strengthen the direct‑care workforce through funding, standards, and data—but it requires substantial federal/state spending, adds administrative and reporting burdens, and includes delayed/conditional benefits that create implementation and privacy risks.
People with disabilities and older adults will gain broader access to home- and community-based services (HCBS) and reduced waiting lists, increasing options to remain in the community rather than institutions.
Direct care and support workers are likely to see stronger pay, benefits, job-quality standards, and clearer occupational recognition, improving recruitment, retention, and workforce stability for roughly millions of caregivers.
Medicaid beneficiaries, families, and HCBS recipients will get more choice and supports—expanded respite, family caregiver supports, self-directed care options, and formal roles in policy—that increase consumer control over services.
Taxpayers and state budgets will face substantial new costs (expanded Medicaid benefits, grant programs, surveys, and potential higher wages), which could pressure other priorities or require additional funding decisions.
States, providers, and grantees will face significant administrative and reporting burdens (planning, data collection, quality reporting, grant compliance) that could strain capacity and raise near‑term implementation costs.
Key benefits are delayed or conditional: the enhanced 100% FMAP is phased in/conditional (multi‑year delay), ACS/survey changes take years to yield results, and annual/staged processes could leave beneficiaries waiting for improvements.
Based on analysis of 6 sections of legislative text.
Requires Medicaid HCBS coverage definitions, directs workforce recommendations and SOC review, creates HCBS quality measures, and mandates a national survey and Census LTSS question.
Requires Medicaid to cover a defined set of home and community‑based services (HCBS) and directs the federal government to strengthen the direct care workforce that provides those services. It creates definitions for HCBS and direct care roles, directs the development of HCBS quality measures, orders interagency workforce recommendations and a SOC classification review, funds a workforce recommendation process, and mandates a national survey and Census question to assess effects. Establishes stakeholder-driven rulemaking and reporting timelines (including an 18‑month recommendation deadline and a 7–9 year national evaluation), provides a $10 million appropriation for workforce recommendations, and authorizes additional funding to carry out the national survey and Census change. The goal is to expand access to HCBS, improve workforce wages/training/quality, and gather national data on long‑term services and supports (LTSS).