PHI Endorses the Senate Reintroduction of the HCBS Access Act
Today, Senator Ben Ray Luján (D-NM) and other sponsors announced the reintroduced of the Home and Community-Based Services (HCBS) Access Act, the Senate companion to legislation PHI endorsed in the House this spring. PHI supports this bill, which reflects policy priorities we have long championed and for which we provided input during development.
Because most Medicaid HCBS are optional for states to provide, and many of those services are delivered through waivers with capped enrollment, 41 states maintain HCBS waiting lists. In 2025, more than 600,000 people were waiting for essential care, facing an average delay of 32 months. More than a quarter century after the Supreme Court held in Olmstead that unjustified segregation of people with disabilities violates the Americans with Disabilities Act—and despite extensive progress across states—the promise of deinstitutionalization has not yet been fully realized within Medicaid. This issue is especially crucial now as the Administration implements the largest cuts in Medicaid history and seeks to narrow federal protections under Olmstead.
The HCBS Access Act would go a long way toward removing structural and programmatic barriers to HCBS. The bill makes HCBS a mandatory Medicaid benefit, defining that benefit to include personal assistance, supported employment, transportation, respite, housing supports, assistive technology, and self-direction. It offers states the opportunity to receive a 100 percent federal match for HCBS spending, meaning the federal government would cover the entire cost of those services for states. The bill also creates new eligibility pathways, permanently extends the Money Follows the Person demonstration, makes spousal impoverishment protections permanent for spouses of people receiving HCBS, and ends estate recovery against families for correctly paid Medicaid benefits.
We cannot successfully increase access to HCBS, however, without a sufficient workforce to provide those services—which requires improving job quality for direct care workers. The bill aims to strengthen the workforce by: tying enhanced federal funding to adequate payment rates and pass-throughs to wages and benefits for workers; funding infrastructure for self-directed care, including matching service registries which help workers and consumers find each other; and recognizing the need to invest in worker recruitment, training, and advancement strategies by authorizing $1 billion for direct are workforce and family caregiver grants and establishing a national technical assistance center to support that work. The bill also directs the Office of Management and Budget to consider a distinct occupational classification for direct support professionals, a change that would finally make this workforce visible in federal and state data.
“Behind every person waiting years for home and community-based services is a job someone couldn’t afford to keep. Direct care workers make it possible for millions of Americans to live at home, yet they are underpaid, inadequately trained, and too often unrecognized for their work, and so the waiting lists grow. The HCBS Access Act recognizes what PHI has said for decades: quality care depends on quality jobs. We thank Senator Luján and the bill’s sponsors for treating care as work worth investing in.”
— Jodi M. Sturgeon, President & CEO, PHI
These provisions align closely with PHI’s federal policy priorities and with our Universal Direct Care Workforce Initiative™, which advances shared competencies, portable credentials, and connected career pathways for direct care workers across settings and states.
PHI extends our gratitude to Senator Luján and the bill’s sponsors for their leadership, and we look forward to working alongside them, our partners, and advocates across the country to advance this bill through Congress.
