Sponsors (2)
Last progress June 9, 2025 (8 months ago)
Introduced on June 9, 2025 by Eric Stephen Schmitt
Amends Social Security Act provisions for Medicaid home- and community-based services (HCBS) waivers to increase transparency and expand who States may cover under certain waivers. It requires new waiver-related information to be posted on the CMS website (beginning Jan 1, 2028) and directs HHS to issue guidance by Jan 1, 2026 allowing up to 60 days of interim HCBS while a written plan of care is finalized. States must meet specified conditions before the Secretary may approve waiver payments for some people who lack a prior eligibility determination under the existing statutory standard.
Amend Section 1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) by modifying paragraph (2)(E) — inserting additional text at two points in that paragraph. (Text inserts are specified but not reproduced here.)
Add new paragraph (11) authorizing the HHS Secretary to approve a 1915(c) waiver for a State to provide payment for part or all of the cost of HCBS (other than room and board) furnished under a written plan of care to individuals who are not the individuals described in paragraph (1), provided the State meets the requirements in paragraph (11)(B).
As a condition for the waiver in paragraph (11), the State must ensure that, as of the date it requests the waiver, with respect to individuals for whom there has not been a determination described in paragraph (1) and who meet the definition of disability under the ADA or section 504, all other waivers (if any) granted under this subsection for the State plan meet the requirements of this subsection.
The State must demonstrate to the Secretary that approving a waiver under paragraph (11) for the individuals described will have no material impact on the average wait time for individuals for whom a paragraph (1) determination has been made to receive HCBS under any waiver granted under this subsection.
The State must provide the Secretary an estimate of the number of such individuals it will make services available to under the waiver and a description of how the types and quantities of services furnished to those individuals may differ from services furnished to individuals described in paragraph (1).
Primary effects will fall on Medicaid HCBS recipients, State Medicaid agencies, providers, and family caregivers. Individuals who need home- and community-based services may gain faster short-term access through up to 60 days of interim coverage while formal care plans are completed, and some people who previously lacked a specific prior determination may become eligible for waiver-funded services if States meet the new conditions. State Medicaid agencies will face new reporting and documentation obligations and must adjust waiver applications and operational processes to meet transparency and approval conditions. Providers and case managers will need to adapt intake and care-planning workflows to support interim coverage and provide the documentation States must submit. HHS/CMS will incur responsibilities to issue guidance and to publish required waiver information publicly, improving oversight and stakeholder visibility but requiring new administrative work. There may be fiscal and operational impacts for States and Medicaid programs depending on how broadly States use the expanded coverage authority and how much additional administrative capacity is required; funding for these state-level costs is not specified in the amendment.
Read twice and referred to the Committee on Finance.