Sponsors (14)
The bill aims to expand and improve HCBS access, workforce capacity, and data-driven oversight—benefiting people with disabilities and seniors and strengthening care jobs—but does so with substantial federal/state spending, sizable administrative requirements, and phased timelines that may delay or limit benefits and strain implementing agencies.
People with disabilities, older adults, and Medicaid beneficiaries will gain expanded access to home- and community-based services (HCBS) including clearer private-duty nursing eligibility and reduced waitlists, enabling more people to remain in community settings rather than institutions.
Direct care and home‑health workforces get stronger recognition, training, career pathways, and standards (including an occupational code), which supports recruitment, retention, better wages/benefits, and more stable care for consumers.
States and providers receive substantial federal financial supports and grants (e.g., enhanced FMAP incentives, an 80% match for reporting, $10M for measure development, $1B in grants and TA funding) to implement HCBS expansions and workforce projects.
Taxpayers and state budgets may face substantially higher costs—through expanded Medicaid benefits, federal grants, and added program spending—potentially pressuring other priorities or requiring future fiscal tradeoffs.
Many key improvements are phased, conditional, or delayed (e.g., 5‑year FMAP timing, multi‑year survey and assessment timelines), so beneficiaries and workers may not see changes for years and some states may lag in implementation.
Extensive planning, reporting, data collection, and compliance requirements create significant administrative burdens and costs for states, providers, grantees, and federal agencies.
Based on analysis of 6 sections of legislative text.
Requires and defines Medicaid coverage of home- and community-based services, strengthens the direct care workforce, creates HCBS quality measures, and mandates data collection and surveys.
Requires Medicaid to cover a defined set of home- and community-based services (HCBS) delivered under individualized plans and in community settings, and directs federal action to strengthen the direct care workforce that provides those services. The bill directs HHS to develop standardized HCBS quality measures, coordinates with Labor on workforce recommendations (including wages, classification, training, and apprenticeships), asks OMB to consider a separate occupational code for direct support professionals, funds a workforce recommendation process, and requires a nationwide survey and Census question to track effects and needs.
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