HCBS Access Act
Sponsored By: Senator Luján, Ben Ray [D-NM]
Introduced
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.
Show full summary
- 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.*
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Bill Overview
Analyzed Economic Effects
7 provisions identified: 6 benefits, 0 costs, 1 mixed.
Medicaid must cover home care
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, supported employment, transportation, home modifications, respite, and housing supports. The bill would also let Medicaid cover HCBS for people whose income is at or below the greater of 150% of the poverty line or 300% of the SSI benefit rate, and it would make HCBS provided in the three months before an application available if the person was eligible when services were given.
Federal money and state duties for HCBS
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 quarters after implementation. States would have to submit a detailed HCBS implementation plan before the benefit starts and set up or contract for a program to support self-directed care (helping beneficiaries hire and manage independent providers). The bill would also add HCBS to the classes that States may tax under Medicaid provider-related tax rules.
New HCBS quality measures and survey
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 independent HCBS ombudsman office to help beneficiaries. The bill would fund metric development with $200 million for fiscal year 2027, $10 million for related measure activities, and would require a national CMS survey and report within seven to nine years, plus an ACS question to identify need for long-term services.
Grants and rules to grow the care workforce
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 million for a Technical Assistance Center for each of fiscal years 2029 and 2030, with funds available through September 30, 2038. The bill would also set definitions for 'direct care professional' and list allowable supportive services for grant activities.
Stronger protections for families' assets
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 liens that are in effect as of enactment within 90 days and notify affected individuals or their legal representatives.
Extend community transition demonstration
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
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.
Sponsors & CoSponsors
Sponsor
Luján, Ben Ray [D-NM]
NM • D
Cosponsors
Sen. Kaine, Tim [D-VA]
VA • D
Sponsored 8/6/2026
Sen. Baldwin, Tammy [D-WI]
WI • D
Sponsored 8/6/2026
Sen. Duckworth, Tammy [D-IL]
IL • D
Sponsored 8/6/2026
Sen. Gillibrand, Kirsten E. [D-NY]
NY • D
Sponsored 8/6/2026
Sen. Hassan, Margaret Wood [D-NH]
NH • D
Sponsored 8/6/2026
Sen. Blumenthal, Richard [D-CT]
CT • D
Sponsored 8/6/2026
Sen. Merkley, Jeff [D-OR]
OR • D
Sponsored 8/6/2026
Sen. Sanders, Bernard [I-VT]
VT • I
Sponsored 8/6/2026
Sen. Warren, Elizabeth [D-MA]
MA • D
Sponsored 8/6/2026
Sen. Reed, Jack [D-RI]
RI • D
Sponsored 8/6/2026
Sen. Markey, Edward J. [D-MA]
MA • D
Sponsored 8/6/2026
Sen. Shaheen, Jeanne [D-NH]
NH • D
Sponsored 8/6/2026
Sen. Fetterman, John [D-PA]
PA • D
Sponsored 8/6/2026
Sen. Kim, Andy [D-NJ]
NJ • D
Sponsored 8/6/2026
Sen. Murray, Patty [D-WA]
WA • D
Sponsored 8/6/2026
Sen. Alsobrooks, Angela D. [D-MD]
MD • D
Sponsored 8/7/2026
Roll Call Votes
No roll call votes available for this bill.
View on Congress.gov