Sponsors (17)
Official title: 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 August 6, 2026 by Ben Ray Luján · Last progress August 6, 2026
The bill creates a major federal push to expand and standardize Medicaid home- and community-based services—improving access, workforce supports, data, and beneficiary protections—while requiring substantial new spending, significant adminstrative work, and phased implementation that could delay benefits and strain state and provider capacity.
Medicaid beneficiaries — especially people with disabilities and older adults — gain a statutory entitlement to Medicaid-funded home- and community-based services (HCBS), expanding access, reducing many waiting lists, and ensuring a pathway to community supports.
Direct care workers and the HCBS workforce will receive stronger supports (higher and reviewable payment rates, training, apprenticeships, career pathways, and formal occupational recognition) that should improve recruitment, retention, and care quality.
States, researchers, and the federal government will get far better data and standardized metrics on HCBS access, utilization, workforce conditions, and demographic equity (including an added ACS question and standardized reporting), enabling targeted planning and accountability.
Federal and state spending will likely rise substantially (mandatory HCBS expansions, grants, surveys, and program supports), creating budgetary pressures for taxpayers and state budgets if enhanced FMAPs or sufficient offsets are not sustained.
Expanding entitlement without immediate provider capacity risks means many beneficiaries could still face delayed access: shortages and turnover among direct support professionals will limit availability until workforce expansion materializes.
States, providers, and smaller eligible entities face substantial administrative, reporting, and compliance burdens (developing plans, collecting standardized data, running ombudsman offices, managing grants), which may divert resources from direct services and limit participation.
Based on analysis of 6 sections of legislative text.
Makes HCBS a required Medicaid service, directs federal support and workforce actions to expand access, track equity/quality, and strengthen the direct care workforce.
Makes home and community-based services (HCBS) an explicit, mandatory Medicaid service category and directs the Department of Health and Human Services to help states expand access, eliminate HCBS waiting lists, and track equity and quality. It also requires federal action to strengthen the direct care workforce—through guidance, grants, apprenticeship and training definitions, an occupational classification review, and national data collection on HCBS availability and workforce conditions. The bill requires the HHS Secretary to issue guidance, provide technical assistance, and develop workforce recommendations; directs OMB to consider creating a separate occupational code for direct support professionals; sets definitions and eligible entities for workforce grants and apprenticeship programs; and mandates a national survey and new Census question to measure long‑term services and supports needs. It includes a $10 million FY2027 appropriation to HHS for implementation support and authorizes additional sums as needed for the mandated survey and data work.