# 119-s-5321: HCBS Access Act 119-s-5321, HCBS Access Act, is a 119th Congress bill sponsored by Sen. Luján, Ben Ray [D-NM] (D-NM); status introduced; PRIA reads it as touching household money (as of 2026-10-03). - Canonical: https://policyrisk.com/legislation/119-s-5321 - As of: 2026-10-03 - Plain-text twin of the page above; the HTML and this file carry the same facts. ## Facts - Bill: 119-s-5321 - Congress: 119 - Title: HCBS Access Act - Status: introduced - Introduced: 2026-08-06 - Sponsor: Sen. Luján, Ben Ray [D-NM] (D-NM) - Cosponsors: 19 - Policy area: Health - Touches household money: yes - Last recorded action: 2026-10-03 ## Summary **This bill would expand Medicaid coverage of home and community‑based services (HCBS) by creating a new mandatory HCBS benefit and linking it to workforce and caregiver supports.** It pairs new eligibility paths, standardized assessments and person‑centered planning, quality reporting, and federal matches and grants to help states, workers, and families access care in the community. - Families and recipients: People who need long‑term supports would be eligible for a new mandatory Medicaid HCBS benefit if they meet functional tests and income thresholds set at 150% of poverty or 300% of the Supplemental Security Income rate. - Direct care workforce: Direct care workers would get new training and qualification standards, required rate reviews, and rules that require pay increases to pass through to workers. The bill creates a national technical assistance center and funds competitive grants including $1.0 billion for grants in FY2029. - States and program implementation: States that meet specified conditions would receive 100% federal matching for qualifying HCBS costs and an 80% federal match for many startup administrative expenses to implement the expansion. *Increases federal spending by providing 100% FMAP for qualifying HCBS and authorizing roughly $1.2 billion in new appropriations across FY2027–FY2030.* ## Cosponsors (19) - Sen. Coons, Christopher A. [D-DE] (D-DE), 2026-09-29T00:00:00.000Z - Sen. Van Hollen, Chris [D-MD] (D-MD), 2026-09-30T00:00:00.000Z - Sen. Kaine, Tim [D-VA] (D-VA), 2026-08-06T00:00:00.000Z - Sen. Baldwin, Tammy [D-WI] (D-WI), 2026-08-06T00:00:00.000Z - Sen. Duckworth, Tammy [D-IL] (D-IL), 2026-08-06T00:00:00.000Z - Sen. Gillibrand, Kirsten E. [D-NY] (D-NY), 2026-08-06T00:00:00.000Z - Sen. Hassan, Margaret Wood [D-NH] (D-NH), 2026-08-06T00:00:00.000Z - Sen. Blumenthal, Richard [D-CT] (D-CT), 2026-08-06T00:00:00.000Z - Sen. Merkley, Jeff [D-OR] (D-OR), 2026-08-06T00:00:00.000Z - Sen. Sanders, Bernard [I-VT] (I-VT), 2026-08-06T00:00:00.000Z - Sen. Warren, Elizabeth [D-MA] (D-MA), 2026-08-06T00:00:00.000Z - Sen. Reed, Jack [D-RI] (D-RI), 2026-08-06T00:00:00.000Z - Sen. Markey, Edward J. [D-MA] (D-MA), 2026-08-06T00:00:00.000Z - Sen. Shaheen, Jeanne [D-NH] (D-NH), 2026-08-06T00:00:00.000Z - Sen. Fetterman, John [D-PA] (D-PA), 2026-08-06T00:00:00.000Z - Sen. Kim, Andy [D-NJ] (D-NJ), 2026-08-06T00:00:00.000Z - Sen. Murray, Patty [D-WA] (D-WA), 2026-08-06T00:00:00.000Z - Sen. Alsobrooks, Angela D. [D-MD] (D-MD), 2026-08-07T00:00:00.000Z - Sen. Schiff, Adam B. [D-CA] (D-CA), 2026-09-14T00:00:00.000Z ## Provisions PRIA read - Medicaid must cover home care: benefit, high. If enacted, Medicaid would be required to cover home and community-based services (HCBS). The rule would start the first calendar quarter that begins on or after five years after enactment. HCBS would be based on an individualized assessment and person-centered plan and could include personal care,… - Federal money and state duties for HCBS: benefit, high. If enacted, States that meet new access and workforce requirements would get enhanced federal matching funds for HCBS, including 100% federal matching for qualifying HCBS spending and for plan development costs. Certain administrative costs would get an 80% federal match for the first 20 fiscal qua… - New HCBS quality measures and survey: benefit, high. If enacted, the Secretary would create standardized state-level HCBS quality metrics within one year. States would have to report using core and supplemental measures no later than two years after those sets are published and report every year after. Each State would be required to set up an indepe… - Grants and rules to grow the care workforce: benefit, high. If enacted, the Secretary would award grants to recruit, train, and keep direct care workers and support family caregivers. Grants must include career pathways and at least 30 percent of projects must offer advancement. The program would authorize $1 billion for grants for fiscal year 2029 and $2 m… - Stronger protections for families' assets: benefit, medium. If enacted, spousal impoverishment protections would be made permanent for people who meet the bill's HCBS eligibility rules. The bill would also bar States from recovering or adjusting medical assistance that was correctly paid on or after enactment. States would have to withdraw existing Medicaid… - Extend community transition demonstration: benefit, medium. If enacted, the Money Follows the Person rebalancing demonstration would continue for fiscal year 2024 and each fiscal year after. This would keep the demonstration active so States can keep using it to help people move from institutions into community settings. - Technical Medicare citation change: mixed, low. If enacted, a statutory citation in the Medicare Part D provisions would be broadened to refer to section 1915, 1115A, or a State plan amendment. This is a technical cross-reference change and should have limited direct effect on households. ## Related bills - 119-s-5066: Health Equity and Accountability Act of 2026 - 119-s-51: Washington, D.C. Admission Act - 119-s-5108: Right to IVF Act of 2026 - 119-s-1503: Equality Act - 119-s-852: Richard L. Trumka Protecting the Right to Organize Act of 2025 - 119-s-2150: Women’s Health Protection Act of 2025 ## Sources - [119-s-5321 on Congress.gov](https://www.congress.gov/bill/119th-congress/senate-bill/5321) ## Related - [119-s-5066: Health Equity and Accountability Act of 2026](https://policyrisk.com/legislation/119-s-5066) - [119-s-51: Washington, D.C. Admission Act](https://policyrisk.com/legislation/119-s-51) - [119-s-5108: Right to IVF Act of 2026](https://policyrisk.com/legislation/119-s-5108) - [119-s-1503: Equality Act](https://policyrisk.com/legislation/119-s-1503) - [119-s-852: Richard L. Trumka Protecting the Right to Organize Act of 2025](https://policyrisk.com/legislation/119-s-852) - [119-s-2150: Women’s Health Protection Act of 2025](https://policyrisk.com/legislation/119-s-2150) - [All bills in Congress](https://policyrisk.com/legislation) Source: PRIA, https://policyrisk.com/legislation/119-s-5321 (as of 2026-10-03).