Medicaid 2028 Revamp: Better Home Care Quality Across Rural and Urban
Published Date: 4/28/2026
Notice
Summary
Starting in 2028, Medicaid will update the quality checks for Home and Community-Based Services (HCBS) to make sure people get better care no matter where they live. States will have to collect and share new kinds of data, including differences between rural and urban areas, to help improve services. Everyone’s invited to share their thoughts by May 28, 2026, so these changes work best for all.
Analyzed Economic Effects
6 provisions identified: 4 benefits, 1 costs, 1 mixed.
Every‑other‑year HCBS Reporting Starts 7/9/2028
If you get Medicaid-funded home and community-based services (HCBS), your State must report on HCBS quality every other year starting July 9, 2028. These reports are required under Sec. 441.311(c) and are intended to track quality and outcomes across States.
Which Quality Measures Will Be Mandatory
CMS proposes a set of 23 mandatory HCBS quality measures for 2028: 2 assessment/case-management measures, 3 administrative measures, and 18 participant-reported survey measures. Because States use different surveys, each State would be expected to report between 9 and 19 measures in 2028 depending on which experience-of-care surveys it uses.
Stratified Reporting by Race, Rural/Urban, More
States must report stratified HCBS measure results by factors including race, ethnicity, sex, age, rural/urban status, disability, and language for measures CMS identifies. Stratified reporting will be phased in: 25% of measures by July 9, 2028; 50% by July 9, 2030; and 100% by July 9, 2032.
States Must Set Performance Targets and QI Plans
States are required to establish performance targets (subject to CMS review) for each mandatory HCBS measure and describe the quality improvement strategies they will use to meet those targets. This requirement is set out in Sec. 441.311(c)(1)(iii).
Children and Youth Measures Are Limited Now
CMS notes a lack of proposed HCBS measures for children and youth and says it expects to propose measures focused on children and youth in the future. If you are a parent or guardian of a child receiving HCBS, this means children-focused quality measures are not yet included in the 2028 set.
Two Survey Measures Not Mandatory in 2028
CMS is not proposing two participant-reported measures as mandatory for 2028: HCBS CAHPS 'Planning Your Time and Activities' composite and POM 'People Live in Integrated Environments.' CMS invites comment on whether these should be required for 2028.
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Key Dates
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