HCBS Access Act

What it does

• •Amends Medicaid law to require all states to cover home and community-based services (HCBS) as a mandatory benefit under state plans, rather than allowing coverage only through optional waivers.
• •Establishes a comprehensive definition of HCBS including personal assistance, supported employment, respite care, housing support, behavioral health services, and other community-based supports, with an advisory panel to recommend additional services every five years.
• •Authorizes federal grants to support creation, recruitment, training, and retention of the direct care workforce, and separate grants to support family caregivers.
• •Creates requirements for individualized assessments, person-centered service plans, quality measurement, and demographic data collection to ensure equitable access across racial, ethnic, gender, and geographic groups.

Why it matters

• •The text states the bill aims to eliminate Medicaid waiting lists for HCBS and ensure individuals with disabilities and older adults can live in communities rather than institutional settings, citing decades of research showing this is feasible.
• •The bill addresses documented disparities by explicitly targeting elimination of 'race, gender, sexual orientation, and gender identity disparities' in HCBS access and aims to improve conditions for approximately 3.2 million direct care workers who are predominantly women, people of color, and immigrants.
• •Converting HCBS from optional state waivers to mandatory coverage would streamline access and reduce administrative burden on states to repeatedly apply for waiver authority.

Who is affected

• •Individuals with disabilities (intellectual, developmental, cognitive, behavioral health, physical disabilities, and substance use disorders) and older adults seeking home and community-based services.
• •States, which must establish HCBS coverage under Medicaid and implement quality standards and data collection requirements.
• •Direct care workers and family caregivers, as the bill includes workforce development grants and family caregiver support programs.

What happens next

The bill was introduced in the Senate on August 6, 2026, read twice, and referred to the Committee on Finance for consideration.