The Medicaid and CHIP Payment Access Commission’s (MACPAC) latest report to Congress explores various aspects of home and community-based services (HCBS) programs, offering data analysis and a look at core payment principals and differences in Medicaid HCBS programs and rate setting. It also highlights challenges facing the workforce providing these services.

Included in Chapter One, Medicaid Payment Policies to Support the Home- and Community-Based Services [HCBS] Workforce of the March 12, 2026 report from MACPAC, a non-partisan legislative branch agency providing support to Congress and the Department of Health and Human Services (HHS), is a  recommendation for the Centers for Medicare and Medicaid Services (CMS) to require states to submit payment adequacy reporting on hourly wages paid to direct care workers in specific HCBS.

This recommendation aligns with provisions from the Medicaid Access Rule to require reporting of Medicaid rate allocation and a controversial requirement to pass 80% of Medicaid payments on to staff through wages and benefits. MACPAC in the report provides analysis of available data, details differences in Medicaid HCBS programs and rate setting, core payment principals, and highlights challenges facing the workforce providing these services.

Authors conclude, “…lack of consistent HCBS payment data presents a barrier to states looking to apply [the] payment principles…”, therefore establishing the need for consistent wage and rate data from states. States are likely already preparing for the collection this data at the provider level, as required by the Access Rule.

The full report includes three more chapters all relating to services available to children.