HCBS Access Act
Overview
Type of Reform: Reforming Medicaid Structures
Description: Expands access to HCBS and ends the Medicaid funding institutional bias by:
- Requiring state Medicaid programs to provide HCBS at the same level as they must cover nursing facility services.
- Eliminating the need for HCBS waivers when HCBS becomes a mandatory benefit.
- Creating additional programs and requirements to support providers who furnish HCBS.
Sponsor/Cosponsors
- Introduced by Rep. Debbie Dingell (D-MI; HR 1493) and Sen. Bob Casey (D-PA; S. 762) on March 9, 2023.
- No co-sponsors.
Impact and Action:
- Senate Committee Referrals: Finance.
- House Committee Referrals: Energy and Commerce, Subcommittee on Health.
Program Details
Participation Criteria
Medicaid enrolled individuals (criteria varies by state).
Conditions for Receiving Benefits Scope of Services
- Eliminates waiting lists and enrollment caps for states HCBS programs.
- Individuals meeting the below requirements are eligible for HCBS:
- Are determined to have a functional impairment that affects daily living and that is expected to last at least 90 days.
- During the five-year period after the bill is enacted, are already receiving HCBS through Medicaid under a demonstration waiver or other state option.
- Income does not exceed the greater of 150% of the federal poverty level or 300% of the Supplemental Security Income (or a higher state-designated limit).
- Are under the age of 21 and are otherwise eligible.
Scope of Services
Establishes minimum, mandatory HCBS benefits, including but not limited to:
- Supported employment and integrated day services.
- Personal assistance, including personal care attendants, direct support professionals, home health aides, private duty nursing, homemakers and chore assistance, and companionship services.
- Non-emergency, nonmedical transportation services to facilitate community integration.
- Respite and other caregiver/family supports.
- Case management, including fiscal intermediary and support brokerage services.
- Direct support services during acute hospitalizations.
- Necessary medical and nursing services to remain in the community (e.g., hospice).
- Home and community-based intensive behavioral health, crisis intervention, and peer supports.
- Housing support, including transitional housing or transitional support services for individuals experiencing homelessness, and wrap-around services.
- Necessary home modifications and assistive technology.
- Transition services to support an individual transitioning from an institutional setting to the community.
- Any other service recommended by the [Secretary-appointed advisory panel].
Amount of Services
Not specified.
Participant Financial Responsibility
Not specified.
Elimination Period
Not applicable.
Provider Requirements
Not specified.
Provider Payment Levels
Not specified.
Inflation Adjustments
Not specified.
Financing & Implementation
Revenue Source(s)
Not specified.
Total Program Costs
No cost estimate available.
Program Administration
- HHS oversees state administration and operation of new Medicaid provisions and must provide:
- 100% federal match funding to states for HCBS for 10 years.
- 80% federal match funding for quality and reporting activities to implement core set and supplemental set of HCBS quality measures.
- Implementation grant funding for states to expand their capacity to meet the needs of people who prefer HCBS, following a detailed implementation plan.
- Oversight and reporting mechanisms include:
- Development and implementation of federally mandated HCBS quality measures for states and Medicaid managed care organizations.
- Aggregation of quality metrics and other data across the full array of HCBS reported by recipients’ demographic characteristics to identify disparities in access and utilization.
- States must involve the following individuals in program design: recipients of home HCBS, family caregivers of such recipients, providers, health plans, direct care workers, chosen representatives of direct care workers, and aging, disability, and workforce advocates.
HCBS Access Act, 2023
(S. 762/H.R. 1493)
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