The HCBS Access Act seeks to fundamentally transform Medicaid's provision of home and community-based services (HCBS) by making them a mandatory benefit for eligible individuals. Its core purpose is to eliminate waiting lists, promote community inclusion, prevent unnecessary institutionalization, and address disparities in access for people with disabilities and older adults. The bill also aims to support the vital role of family caregivers and improve the quality and availability of the direct care workforce. Under Title I, the bill significantly broadens the definition of HCBS to include a wide array of services, from personal assistance and supported employment to housing support and assistive technology. It mandates the Secretary of Health and Human Services to convene an advisory panel to recommend additional services every five years. Eligibility for HCBS is expanded to include individuals with functional impairments, existing HCBS recipients, and those under 21, with a presumption that all eligible individuals can be served in their own homes and communities. To incentivize states, the bill proposes a 100% Federal Medical Assistance Percentage (FMAP) for HCBS, conditioned on states enhancing and expanding services, lowering access barriers, and supporting family caregivers. States must also ensure that payment rates for HCBS are sufficient to recruit and retain a robust direct care workforce, with increases proportionately passed through to workers. An 80% FMAP is provided for administrative costs related to expanding and enhancing HCBS, including data infrastructure and training programs. States will be required to submit an HCBS implementation plan detailing how they will operationalize the new requirements, address workforce issues, coordinate with other state agencies, and build capacity. The bill also makes permanent the Medicaid spousal impoverishment protections for HCBS recipients and the Money Follows the Person rebalancing demonstration. A significant provision is the repeal of the requirement for states to establish Medicaid estate recovery programs and a prohibition on new liens, requiring the withdrawal of existing ones. Title I also mandates the development of standardized, state-level metrics for HCBS access and satisfaction, with funding for state implementation, and requires states to establish an HCBS ombudsman office. Title II addresses the direct support professional workforce, highlighting their critical role and high turnover rates. It directs the Office of Management and Budget to consider establishing a separate occupational code for direct support professionals within the Standard Occupational Classification system to improve data collection and recognition. Title III focuses on supporting the direct care workforce and family caregivers through the establishment of a national technical assistance center. This center will develop recommendations for training curricula, career advancement opportunities, and strategies for supporting family caregivers. The bill authorizes grants to eligible entities for projects aimed at recruiting, retaining, and advancing direct care professionals, including managers and self-directed care professionals, and for supporting family caregivers. Grant project plans must detail workforce demographics, projected unmet needs, compensation strategies, and comprehensive training programs that include rights of recipients, abuse recognition, and culturally competent care. A portion of grant funds must provide direct financial benefits or supportive services to project participants. Finally, Title IV mandates a national survey to evaluate the Act's impact on HCBS access, workforce capacity, and economic effects, and requires the addition of a question to the American Community Survey to identify the need for long-term services and supports.