Sponsors (11)
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 would significantly expand access, data, and federal support for HCBS and strengthen the direct care workforce—benefiting people with disabilities, seniors, and millions of caregivers—but does so with sizable new reporting demands, implementation delays, and fiscal trade-offs that could strain states, providers, and taxpayers.
People with disabilities, seniors, and Medicaid beneficiaries would get broader access to home- and community-based services (HCBS) and shorter or reduced waiting lists, expanding in‑community care options.
Direct care and private‑duty nursing workers would gain stronger recognition, workforce standards, training pathways, and potential wage/benefit improvements, improving recruitment, retention, and job quality for millions of caregivers.
States and providers would receive substantial federal incentives and grants (including conditional 100% FMAP for HCBS expansions, an $1 billion grant authorization, $10M HHS funding, and reporting match incentives) to help pay for expansion and implementation.
States, providers, and grantees will face substantial new planning, reporting, and administrative requirements that could strain budgets and staff capacity and increase overhead.
Taxpayers and state budgets may face sizable new costs—grant appropriations, higher Medicaid spending if wage/benefit increases are implemented, and reduced state recoveries—especially if federal matching conditions are not fully met.
Key benefits are delayed or conditional (e.g., phased/conditional 100% FMAP, multi‑year surveys and assessments), meaning many beneficiaries and workers may not see improvements for years.
Based on analysis of 6 sections of legislative text.
Requires Medicaid coverage of defined home- and community-based services, mandates workforce supports and quality measures, and commissions national data collection on HCBS and direct care workers.
Requires Medicaid to cover home- and community-based services (HCBS) as defined in the bill, strengthens quality measurement, and directs federal action to improve the direct care workforce that serves older adults and people with disabilities. It authorizes federal recommendations, workforce supports, occupational classification review, grant-eligible definitions, a national survey of HCBS impacts, and modest funding to develop workforce recommendations.