HCBS Access Act

Key Points

• The bill makes home and community-based services (HCBS) a mandatory Medicaid benefit in every state, meaning states would be required to cover these services for eligible individuals rather than offering them as optional programs with long waiting lists.
• The federal government would cover 100% of the costs for HCBS under Medicaid, a massive increase from the current federal matching rate. States must use this funding to lower access barriers, support family caregivers, and ensure adequate pay for care workers.
• A $1 billion grant program would be created to recruit, train, and retain direct care workers, along with a national technical assistance center. At least 30% of grant-funded projects must focus on career pathways and advancement opportunities.
• States would be banned from placing liens on Medicaid recipients' property or recovering costs from their estates after death, protecting families from losing their homes to pay back care costs.
• Family caregivers would gain new support including respite care, caregiver assessments, peer supports, and access to assistive technology. An estimated 63 million unpaid family caregivers, who are mostly women, would benefit.
• Most major changes would take effect five years after enactment, giving states time to build implementation plans and workforce capacity. Medicaid eligibility for HCBS would expand to people earning up to 150% of the poverty line or 300% of the SSI benefit rate.