Representatives Debbie Dingell (D-MI) and Jan Schakowsky (D-IL) on April 30, 2026 reintroduced the HCBS Access Act, which would increase options for individuals needing Medicaid funded long-term care by assuring access to home and community-based services (HCBS) for eligible individuals. With phased in provisions, the bill would incorporate HCBS into Medicaid state plans, making them an entitlement on a level playing field with nursing home care and eliminating the need for states’ repeated waiver renewals. As an entitlement, these services would no longer be subject to service caps or waiting lists.

The act proposes to incentivize states’ shift towards community-based services as the location people prefer to age by providing 100% federal matching funds for eligible HCBS. This would effectively eliminate the costs of HCBS for states, shifting the full cost to the federal government. While LeadingAge supports HCBS expansion and access, this provision would make the bill a non-starter for the current majority and limits opportunities for passage.

The bill also includes a provision to establish provider taxes for HCBS providers, which is inherently complicated with the prohibition on new provider taxes in HR 1 and the attribution of federal funds at 100% of cost for covered HCBS. We are working with the congresswoman’s office to better understand the intent and intersection of these provisions.

In support of the policy objectives to expand access to HCBS, the act would invest in workers through grants and the establishment of a technical assistance center to build out the direct care workforce. Grants would be established for eligible applicants to bolster recruitment, retention, and advancement pathways for HCBS workers. Grantees would need to develop a plan and be eligible for funding ongoing projects though funds should not supplant existing funding sources. Applicants would not need to design and establish fully new programs, though applications require researched data on eligible unserved populations, anticipated job growth, and establishment of an advisory body to support grant administration. The plan will also include outcomes reporting, indicating how funds were used and how effectively program goals were attained.

Title IV of the act requires evaluation of the legislation’s impact on the availability and expansion of HCBS. The evaluation calls for establishment and contracting for a National Survey on Expanded HCBS Access between the Centers for Medicare and Medicaid Services (CMS) and the National Academy of Medicine. The evaluation would measure HCBS economic impact, availability of services, capacity of the direct care workforce, and provide recommendations to further expand access to HCBS.

LeadingAge applauds the intent of the bill and its focus on HCBS. We are engaging with Congreswoman Dingell’s office on the bill as they compile feedback for potential edits in advance of future reintroduction in future sessions. The press release announcing the introduction is available here, and the text will be available here.