119th (2025–2027)
S. 5321
# Summary of S. 5321, HCBS Access Act This legislation requires Medicaid to cover home and community-based services (HCBS) for eligible individuals with disabilities and older adults, aiming to eliminate waiting lists and enable people to receive care in their communities rather than institutions. Beginning five years after enactment, states must provide these services—including personal care assistance, supported employment, transportation, housing support, and behavioral health services—to anyone meeting eligibility requirements, with the federal government covering 100 percent of costs for participating states that meet expansion requirements. The bill establishes a substantial workforce development program, directing $1 billion in fiscal year 2029 for grants to support recruitment, training, and retention of direct care workers and family caregivers, recognizing that current shortages and low wages threaten service availability. It creates a national technical assistance center to help states build workforce capacity and establishes quality measurement standards to track service improvements and outcomes across states, with particular attention to reducing disparities for Black, Latino, and other marginalized communities. States must submit comprehensive implementation plans explaining how they will expand services, eliminate access barriers, ensure adequate provider payment rates, establish support for family caregivers, and build workforce infrastructure. The legislation also removes Medicaid liens and recovery provisions that had previously allowed states to recover costs from individuals' estates, eliminates lengthy waiver processes, and extends protections against spousal impoverishment for HCBS recipients. Federal funding includes 80 percent reimbursement for administrative costs during implementation.