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119-hr-8540119th CongressWALLET
HCBS Access Act
Sponsored By: Representative Dingell, Debbie [D-MI-6]
Introduced
Summary
Designates home- and community-based services (HCBS) as a mandatory Medicaid benefit. This bill would expand who can get HCBS, set national quality and workforce standards, and fund grants and technical help to grow community care and support family caregivers.
Show full summary
- Families and people with disabilities would gain broader access to HCBS through higher income limits — up to 150% of the poverty line or 300% of the Supplemental Security Income rate — plus retroactive eligibility for services.
- Direct care workers and family caregivers would get training, career pathways, and supports via a national technical assistance center and grant programs, addressing roughly 3.2 million direct care workers and about 63 million unpaid caregivers.
- States and providers must submit implementation plans to meet access and workforce rules to qualify for a 100% federal match for HCBS, and the bill authorizes major funding including a $1.0 billion grant program.
*This bill would increase federal spending through specified appropriations and by expanding federal Medicaid matching for HCBS.*
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 6 benefits, 0 costs, 1 mixed.
Big federal match for HCBS
The bill would set a 100% federal match for qualifying HCBS spending when a State meets detailed access and workforce conditions (like no-wrong-door, presumptive eligibility, rate reviews at least every two years, and pass-throughs to direct care workers). It would give an 80% federal match for HCBS quality reporting and raise certain administrative matches to 80% for the year before and four years after implementation. The 100% match would not apply to people eligible only under a State higher-income option.
Who qualifies for Medicaid HCBS
The bill would make home and community services a required Medicaid benefit starting the first calendar quarter five years after enactment (States may start earlier). You would qualify if you meet the HCBS functional standard and your income is at or below the greater of 150% of poverty or 300% of the SSI rate. Medicaid could pay for care given up to three months before you apply if you would have been eligible when the care was given. States would have to file implementation plans, do independent assessments within 30 days of eligibility, reassess at least yearly, and set up independent HCBS ombudsman offices.
More funding for care workers
The bill would create a national technical assistance center and a large grant program to grow the direct care workforce and support family caregivers. It authorizes $200 million for FY2026 for state metric work, two $10 million FY2026 amounts for measure work, $1 billion for grants in FY2029, and $2 million per year for a center in FY2029–2030. Grants must fund career pathways, training, on-the-job wage progressions, and supportive services. Grant projects would report annually and be independently evaluated.
Help for people leaving institutions
The bill would make the Money Follows the Person rebalancing demonstration ongoing after 2025 instead of ending in 2027. This would continue federal support for people who move from institutional settings into community living and for States running the demonstration.
Wider Medicare financing options for states
The bill would broaden Medicare cross-references to allow financing or administration under additional State authorities, such as certain waivers or State plan amendments. This would give States more flexibility in how Medicare-related HCBS costs are financed or administered.
Separate job code for care workers
The bill would direct the Office of Management and Budget to consider creating a separate occupational code for direct support professionals in the next code revision. If OMB decides not to create the code, it would have to explain the decision to Congress within 30 days after announcing it.
New provider-tax rules for HCBS
The bill would add home and community services as a specific class for Medicaid provider-tax rules. States could change how they design provider taxes for HCBS providers. The bill itself would not directly raise household taxes or set tax rates.
Sponsors & CoSponsors
Sponsor
Dingell, Debbie [D-MI-6]
MI • D
Cosponsors
Rep. Cleaver, Emanuel [D-MO-5]
MO • D
Sponsored 10/1/2026
Rep. Cisneros, Gilbert Ray [D-CA-31]
CA • D
Sponsored 10/5/2026
Rep. Menefee, Christian D. [D-TX-18]
TX • D
Sponsored 10/9/2026
Rep. McBride, Sarah [D-DE-At Large]
DE • D
Sponsored 10/15/2026
Rep. Williams, Nikema [D-GA-5]
GA • D
Sponsored 10/29/2026
Rep. Deluzio, Christopher R. [D-PA-17]
PA • D
Sponsored 10/26/2026
Rep. Schakowsky, Janice D. [D-IL-9]
IL • D
Sponsored 4/28/2026
Rep. Simon, Lateefah [D-CA-12]
CA • D
Sponsored 5/11/2026
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 5/12/2026
Rep. Davis, Danny K. [D-IL-7]
IL • D
Sponsored 5/13/2026
Rep. Larson, John B. [D-CT-1]
CT • D
Sponsored 5/13/2026
Rep. García, Jesús G. "Chuy" [D-IL-4]
IL • D
Sponsored 5/14/2026
Rep. Grijalva, Adelita S. [D-AZ-7]
AZ • D
Sponsored 6/2/2026
Rep. Waters, Maxine [D-CA-43]
CA • D
Sponsored 7/6/2026
Rep. Barragán, Nanette Diaz [D-CA-44]
CA • D
Sponsored 7/20/2026
Rep. Jackson, Jonathan L. [D-IL-1]
IL • D
Sponsored 7/20/2026
Rep. Ansari, Yassamin [D-AZ-3]
AZ • D
Sponsored 7/27/2026
Rep. Moore, Gwen [D-WI-4]
WI • D
Sponsored 7/27/2026
Rep. Casar, Greg [D-TX-35]
TX • D
Sponsored 7/27/2026
Rep. Pocan, Mark [D-WI-2]
WI • D
Sponsored 8/17/2026
Rep. Balint, Becca [D-VT-At Large]
VT • D
Sponsored 9/14/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov