Sponsors (16)
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 HCBS access and shore up the direct‑care workforce through funding, standards, and data improvements—trading significant new federal/state spending, lengthy implementation and reporting requirements, and transitional/provider capacity risks for improved long‑term access, quality, and worker protections.
People with disabilities, older adults, and other Medicaid/HCBS-eligible individuals gain expanded access to home- and community-based services (HCBS) and reduced waiting lists through new eligibility/coverage requirements and enhanced federal matching incentives.
Direct care and support workers (including direct support professionals, RNs, and LPNs) see strengthened workforce supports — clearer occupational recognition, wage/rate reviews and pass-through rules, grant‑funded training and apprenticeships, and career pathways that should improve pay, retention, and job quality.
States, providers, and the public gain standardized HCBS quality measures, stronger data collection (including an added ACS question), and national assessments that improve transparency, allow tracking of disparities, and inform better planning and resource allocation.
Taxpayers and state budgets face substantial new costs (grants, enhanced benefits, wage and benefit increases) and the main federal incentive (100% FMAP) is conditional and phased in, so states and beneficiaries may see delayed relief and increased fiscal pressure.
States, providers, and agencies will face significant new administrative, planning, and reporting burdens (planning/implementation requirements, quality reporting, demographic data collection, grant administration) that could strain capacity and resources.
Persistent workforce shortages and transition challenges could limit the number of eligible providers and delay services, meaning expanded benefits may not translate into timely access for all beneficiaries.
Based on analysis of 6 sections of legislative text.
Makes Medicaid coverage of a defined set of home- and community-based services mandatory, creates HCBS quality measures, and directs workforce support, data collection, and occupational classification actions.
Requires Medicaid to cover a defined set of home- and community-based services (HCBS), sets new quality measurement and workforce improvement requirements, and directs federal agencies to study and support the direct care workforce. The bill defines HCBS and direct care roles, funds workforce recommendations and a national survey, asks the Bureau of Labor Statistics to consider a distinct occupational code for direct support professionals, and authorizes grants and apprenticeship/education-related definitions to strengthen recruitment, training, and wages. The legislation focuses on expanding access to community-based long-term services and supports, improving quality measurement, and boosting capacity and labor standards for millions of direct care workers and the families and beneficiaries who depend on HCBS.