To provide for an emergency increase in Federal funding to State Medicaid programs for expenditures on home and community-based services.
This bill creates an emergency boost to federal funding for state Medicaid programs to expand home and community-based services (HCBS). Specifically, it temporarily increases the Federal Medical Assistance Percentage (FMAP) by 10 percentage points for HCBS expenditures in fiscal years 2026 and 2027, with a hard cap so the federal share cannot exceed 95%. States eligible for this increase must submit an application describing how they will use the funds to implement specified HCBS improvement activities, ensure funds are spent by September 30, 2029, and use the money to supplement—not replace—current state HCBS funding. The bill outlines a broad slate of permissible activities to strengthen HCBS delivery (e.g., wage increases, paid leave, hazard pay, recruitment and training, assistive technologies, interpreters, and other supports) and provides for reporting, external evaluation, and oversight. It also includes targeted provisions to help individuals who had to relocate to a facility during an emergency return home and continue HCBS services. The overall aims are to improve access, quality, and sustainability of HCBS while expanding the HCBS workforce and addressing urgent needs during the emergency period.
Key Points
- 1Increased FMAP for HCBS: For HCBS expenditures, the federal share of the state’s HCBS Medicaid spending is increased by 10 percentage points for fiscal years 2026 and 2027, up to a maximum federal share of 95%.
- 2Eligible states and approval: A state becomes eligible by submitting an application describing intended HCBS activities; the Secretary must approve the application within 90 days if it is complete.
- 3Authorized activities (subsection d): States may use the funds to implement a wide range of HCBS improvements, including:
- 4- Increasing reimbursement rates for home health agencies and direct support professionals (to support wages) and ensuring increased pay translates to workers.
- 5- Providing paid sick, family, and medical leave; hazard, overtime, and shift differential pay.
- 6- Stabilizing employment (consistent hours, scheduling, benefits).
- 7- Reducing waiting lists and expanding services for those awaiting HCBS.
- 8- Purchasing emergency supplies (e.g., PPE), equipment, and enabling home access (including travel costs for workers).
- 9- Recruiting, training, and supporting home health workers and direct support professionals; assistive technologies and communication supports.
- 10- Providing interpreters and accessible information; ensuring safety during public health emergencies and disasters.
- 11- Allowing day services providers to deliver HCBS; other eligible costs the Secretary deems appropriate (including retainer payments).
- 12- Assisting eligible individuals relocating from homes to nursing facilities or other institutions to move back home, resume HCBS, access mental health and rehabilitative services, and continue services for those on waiting lists while funds are available.
- 13Oversight, reporting, and evaluation:
- 14- States must report by December 31, 2029 on funded activities, number served, and people who resumed HCBS due to the funding.
- 15- An external evaluator will assess overall implementation and outcomes across states, including access, availability, and quality of HCBS, and disseminate findings publicly and to congressional committees.
- 16- States must ensure adequate oversight of federal funds in line with existing Medicaid and waiver regulations.
- 17- The Paperwork Reduction Act does not apply to the reporting requirements in this section.
- 18Definitions and scope: The bill defines HCBS programs, "eligible individuals" for HCBS, Medicaid program, and "State" consistently with federal Medicaid terminology; it also refers to waivers and demonstrations under the Social Security Act.