HCBS Access Act

The HCBS Access Act seeks to transform Medicaid by making home and community-based services (HCBS) a mandatory benefit for eligible individuals, rather than an optional service. This change aims to eliminate extensive waiting lists, ensure community inclusion for individuals with disabilities and older adults, and streamline access by removing the need for states to repeatedly apply for waivers. The bill defines HCBS broadly, including personal assistance, supported employment, respite, caregiver support, and housing assistance, and establishes an advisory panel to recommend additional services. Eligibility for HCBS is based on an annual determination of functional impairment, or existing HCBS receipt, with a presumption that all eligible individuals can be served in their own homes and communities. States must conduct independent, individualized assessments and develop person-centered care plans, with strong safeguards against conflicts of interest and requirements for transparency and accessibility. The Act also modifies Medicaid eligibility to include individuals with incomes up to 150% of the poverty line or 300% of the Supplemental Security Income benefit rate, and ensures retroactive coverage for services. To incentivize state participation, the bill offers a 100% Federal Medical Assistance Percentage (FMAP) for HCBS expenditures to states that enhance, expand, or strengthen their services. Conditions for this enhanced FMAP include lowering access barriers, implementing "No Wrong Door" programs, supporting family caregivers, and ensuring adequate payment rates for HCBS providers and direct care workers. States must review and update payment rates every two years, with a focus on passing increases through to direct care workers and involving stakeholders in the process. The Act requires states to establish an HCBS infrastructure to support self-directed care models, including registering qualified direct care workers, assisting beneficiaries in finding workers, and ensuring care safety and quality. States must also submit detailed implementation plans outlining how they will operationalize HCBS coverage, address workforce issues, coordinate with other agencies, and prioritize individuals on waiting lists. Significant federal funding is provided for administrative costs associated with developing these plans and enhancing Medicaid data and technology infrastructure. Beyond service provision, the bill mandates the development and publication of core and supplemental HCBS quality measures, requiring states to report annually on service quality. It also requires states to establish an independent HCBS ombudsman office to assist beneficiaries and identify systemic problems. Furthermore, the Act makes permanent the extended protection against spousal impoverishment for HCBS recipients and permanently extends the Money Follows the Person rebalancing demonstration program. The bill addresses the direct care workforce by requiring the Office of Management and Budget to consider establishing a separate occupational code for direct support professionals (DSPs) within the Standard Occupational Classification system. This aims to better recognize their critical role, improve data collection on workforce shortages and turnover, and distinguish their work from other care roles. The Secretary of Health and Human Services, in consultation with other agencies, will establish a national technical assistance center to support DSP creation, training, recruitment, retention, and advancement, as well as family caregiver support. A grant program will award funds to eligible entities, including states, labor organizations, and educational institutions, to create projects for recruiting, retaining, and advancing direct care professionals and supporting family caregivers. These projects must include career pathways, provide education on recipient rights and abuse recognition, and offer supportive services like transportation and child care. Grant recipients must submit detailed project plans and report annually on outcomes, including workforce demographics, vacancy rates, and participant satisfaction. Finally, the Act mandates a national survey, conducted by the Administrator of the Centers for Medicare & Medicaid Services, to evaluate the impact of the legislation on HCBS availability, direct care workforce capacity and compensation, and family caregivers. The Secretary of Commerce is also directed to add a question to the American Community Survey to identify the need for long-term services and supports, ensuring ongoing data collection and evaluation of the program's effectiveness.