A Democratic bill with 18 Democratic cosponsors · See all 19 cosponsors
Last activity — Read twice and referred to the Committee on Finance.
In committee
Introduced and handed to a committee in the chamber it started in.
The committee holds it, and most bills are never heard from again. A hearing or a committee vote would be news; silence is the usual outcome, and it kills the bill without anyone voting against it.
Its path through Congress
- Introduced
- In Committee
What this bill would do
The HCBS Access Act aims to require and expand access to home and community-based services (HCBS) under the Medicaid program. It seeks to eliminate waiting lists for these services to prevent unnecessary institutionalization for older adults and people with disabilities. The bill provides for grants to recruit, train, and retain the direct care workforce and offers support for family caregivers. It also modifies Medicaid eligibility and mandates the creation of an ombudsman office in each state. Additionally, it establishes a national technical assistance center to support the direct care workforce.
Yes· 3 of 45
- Scored +10
Would people over 65 be better off under this?
Significantly increases access to home and community-based services for older adults.
- Scored +10
Would people with disabilities be better off under this?
Removes waiting lists and mandates coverage for a wide range of community-based services.
- Scored +10
Would retired people be better off under this?
Greatly expands the ability of retirees to receive long-term care at home rather than in institutions.
The opposite· 3 of 4
- Scored -6
Does this reduce what the federal government spends?
Authorizes substantial new appropriations for workforce grants and technical assistance.
- Scored -4
Does this leave more decisions to the states?
Reduces state flexibility by making HCBS a mandatory benefit.
- Scored -4
Does this reduce what the federal government owes?
Increases federal spending through new grants and a 100% FMAP for HCBS.
Who it would affect, and how
Potential Positive Impacts for People
- Increased Access to Care: The bill requires Medicaid coverage for HCBS to eliminate waiting lists and ensure people with disabilities and older adults can live in their communities (Section 101).
- Broad Range of Covered Services: It specifies a wide array of supported services, including personal assistance, respite services, housing support, and nutrition services (Section 102(a)(2)).
- Support for Family Caregivers: The act requires states to provide supports for family caregivers, such as respite care and potentially paid caregiving (Section 102(d)(2)(C)).
- Improved Worker Wages and Benefits: It mandates that payment rate increases be proportionately passed through to direct care workers and requires states to ensure compensation is sufficient to recruit and retain workers (Section 102(d)(2)(D)-(E)).
- Financial Protections: The bill makes permanent the protection against spousal impoverishment for HCBS recipients (Section 108) and requires the withdrawal of certain medical assistance liens (Section 110).
- Workforce Development: It authorizes grants for the recruitment, training, and professional advancement of direct care professionals and managers (Section 303(a)(2)).
Potential Negative Impacts for People
- Wait Period for Benefits: The mandatory benefit and certain eligibility modifications do not take effect until the first calendar quarter that begins on or after five years from the date of enactment (Section 102(b)(2)).
- Eligibility Restrictions: Access to these services is limited to "eligible individuals" who must have a functional impairment expected to last at least 90 days (Section 102(a)(2)(3)(A)(i)).
- Income Caps: Some eligibility for the expanded services is capped at 150 percent of the poverty line or 300 percent of the supplemental security income benefit rate, depending on the category (Section 103(1)(A)(i)).
Groups and Interests Ranking
Every group the model scored this bill for, from -10 to +10. Tap or hover a score for the reason it gave.
- Demographic And Interest Groups
- Would people with disabilities be better off under this? — Removes waiting lists and mandates coverage for a wide range of community-based services. Would retired people be better off under this? — Greatly expands the ability of retirees to receive long-term care at home rather than in institutions. Would people over 65 be better off under this? — Significantly increases access to home and community-based services for older adults. Would households on low incomes be better off under this? — Expands Medicaid benefits and eligibility for those below 150% of the poverty line. Would women be better off under this? — Provides critical supports and grants for family caregivers, who are predominantly women. Would Black Americans be better off under this? — Targets the reduction of disparities and institutionalization for black and brown individuals. Would children be better off under this? — Expands HCBS access for individuals under age 21. Would Hispanic Americans be better off under this? — Targets the reduction of disparities and institutionalization for black and brown individuals. Would Native Americans be better off under this? — Requires consultation with Indian tribes and urban Indian health organizations. Would union members be better off under this? — Supports collective bargaining and protects the rights of direct care labor organizations. Would immigrants be better off under this? — Provides specific support and workforce development for immigrants in the direct care sector. Would LGBTQ people be better off under this? — Mandates addressing disparities based on sexual orientation and gender identity. Would men be better off under this? — Increases access to essential home-based healthcare services. Would people in middle age be better off under this? — Provides critical support for adults with disabilities to live independently. Would people in rural areas be better off under this? — Specifically mandates equitable geographic diversity in grant awards for rural areas. Would people in cities be better off under this? — Expands access to services and workforce grants in urban areas. Would veterans be better off under this, taking everything together? — Improves access to home-based care and involves veterans' organizations in policy. Would white Americans be better off under this? — Expands available home-based services for all eligible seniors and disabled persons. Would people in their twenties and thirties be better off under this? — Improves access to community-based supports for young adults with disabilities. Would Asian Americans be better off under this? — Improves overall access to HCBS and mandates demographic data collection. Would middle-income households be better off under this? — Allows states to set higher income levels for certain eligible individuals. Would students be better off under this? — Provides grants for training and professional advancement in the direct care field.
- Social Issues And Justice
- Does this expand the rights of people with disabilities? — Ensures the right to live in the community and eliminates waiting lists for essential services. Is this likely to lift people out of poverty? — Protects against spousal impoverishment and removes medical assistance liens. Does this make housing cost less? — Includes housing support and transitional housing for unhoused individuals in HCBS. Does this narrow racial gaps in how people are treated? — Explicitly aims to prevent unnecessary institutionalization of black and brown individuals. Is this likely to reduce homelessness? — Provides targeted transition services for individuals who are unhoused. Does this narrow the gap between how men and women are treated? — Provides specific support for family caregivers who are disproportionately women. Does this expand the rights of LGBTQ people? — Mandates data collection and an evaluation of disparities based on sexual orientation and gender identity.
- Healthcare
- Does this make health care easier to get in general? — Eliminates waiting lists for HCBS and expands eligibility for older adults and people with disabilities. Does this put more money into Medicaid, the health coverage for people on low incomes? — Mandates HCBS coverage and provides 100% federal matching for qualifying states. Does this make mental health care easier to get? — Specifically includes behavioral health and crisis intervention services in HCBS. Does this lower what a hospital stay costs? — Aims to prevent unnecessary institutionalization through home-based care. Does this help veterans get medical care? — Includes disabled veterans organizations in the advisory panel for service recommendations. Does this put more money into medical research? — Funds evaluations and data collection on the impact of HCBS access.
- Governance And Ideology
- Does this give the federal government more power? — Imposes new mandatory benefits and requirements on state Medicaid programs. Does this make what the government does easier for the public to see? — Requires public reporting of quality measures and implementation progress. Does this protect the right to fair treatment by the courts? — Ensures individualized assessments and person-centered planning for benefits. Does this leave more decisions to the states? — Reduces state flexibility by making HCBS a mandatory benefit.
- Environment Energy And Infrastructure
- Does this invest in rural communities? — Requires equitable geographic diversity in grant distribution, including rural areas. Does this improve buses, trains and other public transport? — Provides non-emergency non-medical transportation services to facilitate community integration.
- Economy And Finance
- Is this likely to create jobs? — Provides grants for recruitment and training of the direct care workforce. Does this strengthen the rights of workers to organise? — Requires states to be neutral or cooperate with labor organizations representing direct care workers. Does this give people more protection from unfair business practices? — Establishes an independent ombudsman office to protect beneficiaries' rights. Is this likely to grow the economy? — Invests in workforce development and expands healthcare service delivery. Does this reduce what the federal government spends? — Authorizes substantial new appropriations for workforce grants and technical assistance. Does this reduce what the federal government owes? — Increases federal spending through new grants and a 100% FMAP for HCBS. Does this make the government pay for what it commits to? — Significantly increases federal financial obligations via Medicaid funding.
- National Security And Foreign Policy
- Does this increase the pay, pensions or support veterans receive? — Increases access to home-based care for disabled veterans.
- 9/30/2026
- 1 Cosponsor added.
- 9/29/2026
- 1 Cosponsor added.
- 9/14/2026
- 1 Cosponsor added.
- 8/7/2026
- 1 Cosponsor added.
- 8/6/2026
- Read twice and referred to the Committee on Finance.
- 15 Cosponsors added.
- Introduced in Senate
2 bills Congress.gov lists as related to this one — companions in the other chamber, earlier versions, and bills this one absorbed or was folded into.
Angela AlsobrooksDemocrat · Maryland
Tammy BaldwinDemocrat · Wisconsin
Richard BlumenthalDemocrat · Connecticut
Christopher CoonsDemocrat · Delaware
Tammy DuckworthDemocrat · Illinois
John FettermanDemocrat · Pennsylvania
Kirsten GillibrandDemocrat · New York
Maggie HassanDemocrat · New Hampshire
Timothy KaineDemocrat · Virginia
Andy KimDemocrat · New Jersey
Edward MarkeyDemocrat · Massachusetts
Patty MurrayDemocrat · Washington
Jeff MerkleyDemocrat · Oregon
John ReedDemocrat · Rhode Island
Bernie SandersIndependent · Vermont
Adam SchiffDemocrat · California
Jeanne ShaheenDemocrat · New Hampshire
Chris Van HollenDemocrat · Maryland
Elizabeth WarrenDemocrat · Massachusetts