Jul '25 (edited) • General discussion
One Big Beautiful Bill
In regard to the "One Big Beautiful Bill" that folks have major concerns about, I encourage you all to read it. Chapter 1 covers everything medicaid related. It's not too long of a read.
Home or Community Based Services actually have a whole section in the bill. It is the final subsection of chapter 1.
Here it is.
Subchapter E--Expanding Access to Care
SEC. 71121. MAKING CERTAIN ADJUSTMENTS TO COVERAGE OF HOME OR
COMMUNITY-BASED SERVICES UNDER MEDICAID.
(a) Expanding HCBS Coverage Under Section 1915(c) Waivers.--Section
1915(c) of the Social Security Act (42 U.S.C. 1396n(c)) is amended–
(1) in paragraph (3), by inserting ``paragraph (11) or''
before ``subsection (h)(2)''; and
(2) by adding at the end the following new paragraph:
``(11) Expanding Coverage for Home or Community-based Services.--
``(A) In general.--Beginning July 1, 2028, notwithstanding
paragraph (1), the Secretary may approve a waiver that is
standalone from any other waiver approved under this subsection
to include as medical assistance under the State plan of such
State payment for part or all of the cost of home or community-
based services (other than room and board (as described in
paragraph (1))) approved by the Secretary which are provided
pursuant to a written plan of care to individuals described in
subparagraph (B)(iii). A waiver approved under this paragraph
shall be for an initial term of 3 years and, upon the request
of the State, shall be extended for additional 5-year periods
unless the Secretary determines that for the previous waiver
period the requirements specified under this subsection
(excluding those excepted under subparagraph (B)) have not been
Met.
``(B) State requirements.--In addition to the requirements
specified under this subsection (except for the requirements
described in subparagraphs (C) and (D) of paragraph (2) and any
other requirement specified under this subsection that the
Secretary determines to be inapplicable in the context of a
waiver that does not require individuals to have a
determination described in paragraph (1)), a State shall meet
the following requirements as a condition of waiver approval:
``(i) As of the date that such State requests a
waiver under this subsection to provide home or
community-based services to individuals described in
clause (iii), all other waivers (if any) granted under
this subsection to such State meet the requirements of
this subsection.
``(ii) The State demonstrates to the Secretary that
approval of a waiver under this subsection with respect
to individuals described in clause (iii) will not
result in a material increase of the average amount of
time that individuals with respect to whom a
determination described in paragraph (1) has been made
will need to wait to receive home or community-based
services under any other waiver granted under this
subsection, as determined by the Secretary.
``(iii) The State establishes needs-based criteria,
subject to the approval of the Secretary, regarding who
will be eligible for home or community-based services
under a waiver approved under this paragraph without
requiring such individuals to have a determination
described in paragraph (1), and specifies the home or
community-based services such individuals so eligible
will receive.
``(iv) The State establishes needs-based criteria
for determining whether an individual described in
clause (iii) requires the level of care provided in a
hospital, nursing facility, or an intermediate care
facility for individuals with developmental
disabilities under the State plan or under any waiver
of such plan that are more stringent than the needs-
based criteria established under clause (iii) for
determining eligibility for home or community-based
Services.
``(v) The State attests that the State's average
per capita expenditure for medical assistance under the
State plan (or waiver of such plan) provided with
respect to such individuals enrolled in a waiver under
this paragraph will not exceed the State's average per
capita expenditure for medical assistance for
individuals receiving institutional care under the
State plan (or waiver of such plan) for the duration
that the waiver under this paragraph is in effect.
``(vi) The State provides to the Secretary data (in
such form and manner as the Secretary may specify)
regarding the number of individuals described in clause
(iii) with respect to a State seeking approval of a
waiver under this subsection, to whom the State will
make such services available under such waiver.
``(vii) The State agrees to provide to the
Secretary, not less frequently than annually, data for
purposes of paragraph (2)(E) (in such form and manner
as the Secretary may specify) regarding, with respect
to each preceding year in which a waiver under this
subsection to provide home or community-based services
to individuals described in clause (iii) was in
Effect–
``(I) the cost (as such term is defined by
the Secretary) of such services furnished to
individuals described in clause (iii), broken
down by type of service;
``(II) with respect to each type of home or
community-based service provided under the
waiver, the length of time that such
individuals have received such service;
``(III) a comparison between the data
described in subclause (I) and any comparable
data available with respect to individuals with
respect to whom a determination described in
paragraph (1) has been made and with respect to
individuals receiving institutional care under
this title; and
``(IV) the number of individuals who have
received home or community-based services under
the waiver during the preceding year.
``(C) Limitation on payments.--No payments made to carry
out this paragraph shall be used by a State to make payments to
a third party on behalf of an individual practitioner for
benefits such as health insurance, skills training, and other
benefits customary for employees, in the case of a class of
practitioners for which the program established under this
title is the primary source of revenue.''.
(b) Implementation Funding.--
(1) In general.--There are appropriated, out of any monies
in the Treasury not otherwise appropriated, to the
Administrator of the Centers for Medicare & Medicaid Services--
(A) for fiscal year 2026, $50,000,000 for purposes
of carrying out the provisions of, and the amendments
made by, this section, to remain available until
expended; and
(B) for fiscal year 2027, $100,000,000 for purposes
of making payments to States, subject to paragraph (2),
to support State systems to deliver home or community-
based services under section 1915(c) of the Social
Security Act (42 U.S.C. 1396n(c)) (as amended by this
section) or under section 1115 of such Act (42 U.S.C.
1315), to remain available until expended.
(2) Payments based on state hcbs eligible population.--
Payments to States from amounts made available by paragraph
(1)(B) shall be made, with respect to a State, on the basis of
the proportion of the population of the State that is receiving
home or community-based services under section1915(c) of the
Social Security Act (42 U.S.C. 1396n(c)) (as amended by this
section) or under section 1115 of such Act (42 U.S.C. 1315), as
compared to all States.
All in all, the fed is allocating $150 million to increase HCBS waiver services. While this is not a lot, it literally tells us that they are expanding HCBS services, not cutting them.
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One Big Beautiful Bill
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