[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 5321 Introduced in Senate (IS)]
<DOC>
119th CONGRESS
2d Session
S. 5321
To amend title XIX of the Social Security Act to require coverage of,
and expand access to, home and community-based services under the
Medicaid program to award grants for the creation, recruitment,
training and education, retention, and advancement of the direct care
workforce and to award grants to support family caregivers and for
other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
August 6, 2026
Mr. Lujan (for himself, Mr. Kaine, Ms. Baldwin, Ms. Duckworth, Mrs.
Gillibrand, Ms. Hassan, Mr. Blumenthal, Mr. Merkley, Mr. Sanders, Ms.
Warren, Mr. Reed, Mr. Markey, Mrs. Shaheen, Mr. Fetterman, Mr. Kim, and
Mrs. Murray) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To amend title XIX of the Social Security Act to require coverage of,
and expand access to, home and community-based services under the
Medicaid program to award grants for the creation, recruitment,
training and education, retention, and advancement of the direct care
workforce and to award grants to support family caregivers and for
other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``HCBS Access Act''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Definitions.
TITLE I--REQUIRING AND EXPANDING ACCESS TO HCBS COVERAGE UNDER MEDICAID
Sec. 101. Purpose.
Sec. 102. Requiring coverage of home and community-based services under
the Medicaid program.
Sec. 103. Medicaid eligibility modifications.
Sec. 104. Home and community-based services implementation plan.
Sec. 105. Quality of services.
Sec. 106. Reports; technical assistance; other administrative
requirements.
Sec. 107. Quality measurement and improvement.
Sec. 108. Making permanent the extended protection under medicaid for
recipients of home and community-based
services against spousal impoverishment.
Sec. 109. Permanent extension of money follows the person rebalancing
demonstration.
Sec. 110. Liens, adjustments, and recoveries for medical assistance.
Sec. 111. HCBS provider tax.
Sec. 112. Medicare amendment.
TITLE II--RECOGNIZING THE ROLE OF DIRECT SUPPORT PROFESSIONALS
Sec. 201. Findings.
Sec. 202. Revision of standard occupational classification system.
TITLE III--SUPPORT FOR THE DIRECT CARE WORKFORCE
Sec. 301. Definitions.
Sec. 302. Authority to establish a technical assistance center for
building the direct care workforce.
Sec. 303. Authority to award grants.
Sec. 304. Project plans.
Sec. 305. Evaluations and reports; technical assistance.
Sec. 306. Authorization of appropriations.
TITLE IV--EVALUATION
Sec. 401. Evaluation of impact on access to HCBS.
SEC. 2. DEFINITIONS.
In this Act:
(1) Demographics.--The term ``demographics'' means
information relating to the races, ethnicities, genders, sexual
orientations, gender identities, geographic locations, incomes,
primary languages, types of service setting, and disability
types represented within a particular group of individuals.
(2) Secretary.--Except as otherwise provided, the term
``Secretary'' means the Secretary of Health and Human Services.
TITLE I--REQUIRING AND EXPANDING ACCESS TO HCBS COVERAGE UNDER MEDICAID
SEC. 101. PURPOSE.
It is the purpose of this title to require coverage of home and
community-based services (in this section referred to as ``HCBS'')
under a State plan (or waiver of such plan) under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.) for the following reasons:
(1) To eliminate waiting lists for HCBS, which delay access
to necessary services and deny access to the promise of
community inclusion guaranteed under the Americans with
Disabilities Act of 1990 (42 U.S.C. 12101 et seq.) for
individuals with disabilities and older adults.
(2) To build on decades of progress in serving individuals
with disabilities and older adults through access to HCBS.
(3) To fulfill the purposes of the Medicaid program to
provide medical assistance for individuals whose income and
resources are insufficient to meet the costs of necessary
medical services, and to provide rehabilitation, long-term
services and supports, and other services to help such
individuals attain or retain capacity for independence or self-
care.
(4) To ensure that individuals with all kinds of
disabilities and with multiple disabilities, including
intellectual disabilities, cognitive disabilities,
developmental disabilities, behavioral health disabilities,
physical disabilities, and substance use disorders, and older
adults, receive the services they need to live in their
communities.
(5) To streamline access to HCBS by eliminating the need
for States to repeatedly apply for waivers of their respective
State plans for medical assistance.
(6) To continue to increase the capacity of community
services to ensure individuals with disabilities and older
adults have high-quality, safe, and meaningful options to
receive care in their community and are not at risk of
unnecessary institutionalization.
(7) To act on the decades of research and practice that
show that everyone, including individuals with the most severe
disabilities, can live in the community with the right services
and supports.
(8) To eliminate the race, gender, sexual orientation, and
gender identity disparities that exist in accessing information
and HCBS and to prevent the unnecessary impoverishment and
institutionalization of black and brown individuals with
disabilities and older adults.
(9) To support over 63,000,000 unpaid family caregivers,
who are disproportionately women and often providing complex
services and supports to older adults and individuals with
disabilities because of a lack of affordable services,
workforce shortages, and other inefficiencies.
(10) To improve direct care quality and ensure access to
services by improving workforce standards for the nearly
3,200,000 direct care workers, who are primarily women, people
of color, and immigrants facing heightened risks of
discrimination in employment, providing support to individuals
with disabilities and older adults in their homes and
communities.
SEC. 102. REQUIRING COVERAGE OF HOME AND COMMUNITY-BASED SERVICES UNDER
THE MEDICAID PROGRAM.
(a) Definition of Home and Community-Based Services.--
(1) Inclusion as medical assistance.--Section 1905(a) of
the Social Security Act (42 U.S.C. 1396d(a)) is amended--
(A) in paragraph (31), by striking ``and'' at the
end;
(B) by redesignating paragraph (32) as paragraph
(33); and
(C) by inserting after paragraph (31) the following
new paragraph:
``(32) home and community-based services (as defined in
subsection (ll)); and''.
(2) Home and community-based services defined.--Section
1905 of the Social Security Act (42 U.S.C. 1396d) is amended by
adding at the end the following new subsection:
``(ll) Home and Community-Based Services.--
``(1) In general.--For purposes of this title, the term
`home and community-based services' means those services
specified in paragraph (2) furnished to an eligible individual
(as defined in paragraph (3)), based on an individualized
assessment (as described in paragraph (4)) and person-centered
service plan (as described in paragraph (4)(D)) for such
individual, in a setting that--
``(A) meets the qualities specified in paragraph
(1) of section 441.710(a) of title 42, Code of Federal
Regulations (or a successor regulation);
``(B) is not described in paragraph (2) of such
section (or a successor regulation); and
``(C) meets such other qualities as the Secretary
determines appropriate in line with recommendations for
additional services made by the advisory panel
described in paragraph (2)(B) of this subsection.
``(2) Services specified.--
``(A) In general.--For purposes of paragraph (1),
the services specified in this paragraph are services
described in any of paragraphs (7), (8), (13)(C), (19),
(20), (22), (24), (29), and (33) of subsection (a) of
this section or in any of subsections (c)(4)(B),
(c)(5), (k)(1)(A), (k)(1)(B), or (k)(1)(D) of section
1915, including the following:
``(i) Supported employment and integrated
day services.
``(ii) Personal assistance, including
personal care attendants, direct support
professionals, home health aides, private duty
nursing, homemakers and chore assistance, and
companionship services.
``(iii) Services that enhance independence,
inclusion, and full participation in the
broader community.
``(iv) Non-emergency, non-medical
transportation services to facilitate community
integration.
``(v) Respite services provided in the
individual's home or broader community.
``(vi) Caregiver and family support
services.
``(vii) Case management, including
intensive case management, fiscal intermediary,
and support brokerage services.
``(viii) Services that support person-
centered planning and self-direction.
``(ix) Direct support services during acute
hospitalizations.
``(x) Necessary medical and nursing
services not otherwise covered that are
necessary in order for the individual to remain
in their home and community, including hospice
services.
``(xi) Home and community-based intensive
behavioral health and crisis intervention
services.
``(xii) Peer support services.
``(xiii) Housing support, including
transitional housing or transitional support
services for individuals who are unhoused, and
wrap-around services.
``(xiv) Necessary home modifications and
assistive technology, including those that
substitute for human assistance.
``(xv) Transition services to support an
individual who is transitioning from an
institutional setting to the community,
including appropriate services for individuals
who are unhoused or at risk of becoming
unhoused, and including such transition
services provided while the individual resides
in an institution.
``(xvi) Nutrition services.
``(xvii) Assisted living services.
``(xviii) Any other service approved by the
Secretary, pursuant to the recommendation of
the advisory panel convened under subparagraph
(B).
``(B) Specification of recommended services.--
``(i) In general.--Not later than 6 months
after the date of the enactment of this
subparagraph, and not less frequently than once
every 5 years thereafter, the Secretary shall
appoint an advisory panel for purposes of
recommending additional services which may be
included as home and community-based services
under this paragraph.
``(ii) Composition.--
``(I) Selection.--The advisory
panel shall be comprised of not less
than 50 members and include
representatives of the following
categories, with the majority of all
members being selected from the
categories described in items (aa),
(bb), and (cc):
``(aa) Individuals with
disabilities receiving home and
community-based services under
this title and individuals with
disabilities in need of such
services, including those with
physical disabilities,
behavioral health disabilities,
or intellectual or
developmental disabilities, and
including older adults, that
are representative of multiple
States, geographical locations,
races, ethnicities, and other
demographic factors.
``(bb) Beneficiary-led
disability rights
organizations.
``(cc) Disability-led
organizations.
``(dd) Disabled veterans
organizations.
``(ee) Disability
organizations representing
families.
``(ff) Organizations
serving individuals with
disabilities, including
intellectual or developmental
disabilities.
``(gg) Organizations
serving older adults.
``(hh) Direct care workers
and the labor organizations
that represent such workers.
``(ii) The Protection and
Advocacy System.
``(jj) The Centers for
Independent Living.
``(kk) Health care
providers.
``(ll) The National
Association of Medicaid
Directors.
``(mm) The National
Association of State Directors
of Developmental Disabilities
Services.
``(nn) The National
Association of State Mental
Health Program Directors.
``(oo) Advancing States.
``(pp) The Centers for
Medicare & Medicaid Services.
``(qq) The Administration
for Community Living of the
Department of Health and Human
Services.
``(rr) Members of federally
recognized tribes and tribally
led organizations.
``(ss) Other relevant
Federal, State, and local home
and community-based service
systems, as determined by the
Secretary.
``(II) Requirement for
proportionate representation.--The
Secretary shall seek to ensure
proportionate representation among each
category described in items (dd)
through (ss) of subclause (I) in
convening the advisory panel.
``(iii) Duties.--
``(I) In general.--Not later than 2
years after an advisory panel is
convened under clause (i), the advisory
panel shall submit to the Secretary and
to Congress a report recommending
additional services which may be
included as home and community-based
services under this paragraph wi