The Helping Communities with Better Support Act would amend title XIX of the Social Security Act to increase transparency around home and community-based services (HCBS) and expand coverage options under Medicaid. It would authorize a new waiver pathway under 1915(c) allowing states to fund all or part of HCBS costs under their state plans for certain individuals through a written plan of care, if specific criteria are met.
Beginning in 2028, the bill also requires public data on waiver processes, access, and service delivery, and directs the Department of Health and Human Services to issue guidance on interim coverage for HCBS up to 60 days while a final plan is finalized.
At a Glance
What It Does
The bill amends 1915(c) to permit waivers that cover HCBS costs under state plans for certain individuals, subject to defined criteria, and requires public reporting on waiver data starting in 2028.
Who It Affects
State Medicaid programs, CMS, HCBS providers (e.g., home health, homemaker, personal care), and individuals eligible for HCBS waivers.
Why It Matters
It expands access to home and community-based care, increases transparency about wait times and service delivery, and clarifies interim coverage steps, affecting policy, operations, and provider capacity.
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What This Bill Actually Does
The bill restructures how HCBS are funded under Medicaid by creating a pathway for states to treat certain HCBS costs as medical assistance under their state plans, with approvals contingent on criteria outlined by the Secretary. It also adds comprehensive data reporting requirements to publicly disclose information about waitlists, eligibility, re-screening, service start times, and actual hours furnished under waivers.
In parallel, the bill directs the Secretary to issue guidance on interim coverage for HCBS up to 60 days between eligibility determination and final written plans of care.
Practically, this means states could extend HCBS coverage beyond current limits if they meet the specified tests, and CMS would publish detailed waiver-related metrics beginning in 2028. Providers and state agencies would need to align administrative processes with new reporting standards, while beneficiaries could gain faster access to services and clearer timelines.
The combination of expanded access and enhanced transparency is intended to improve planning, reduce unnecessary institutional care, and support home- and community-based care delivery.
The Five Things You Need to Know
The bill authorizes a waiver pathway under 1915(c) to cover all or part of HCBS costs under the state plan for certain individuals with a written plan of care.
Public reporting on waiver data must be published by CMS starting January 1, 2028, including waitlists, eligibility, re-screening, and service delivery metrics.
States must provide estimates of the number of individuals to be served under waivers and describe how service types and quantities may differ under the waiver.
The bill requires data on the time from approval to service start and the actual hours of HCBS furnished, by service type and year, under waivers.
Finally, DHHS must issue guidance by January 1, 2026 clarifying interim HCBS coverage for up to 60 days from eligibility determination to final written plans.
Section-by-Section Breakdown
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Expanded HCBS coverage through 1915(c) waivers
The core mechanism is the new authority to approve waivers under 1915(c) that allow some or all HCBS costs to be paid as medical assistance under a state plan for individuals described in the new criteria, provided the state meets subparagraph (B) requirements. This includes demonstrating that waiver approval will not materially delay access and requires the state to provide to the Secretary estimates of the affected population and a description of how service types and quantities may differ from standard recipients. The practical effect is to broaden funding flexibility for HCBS while tying approval to measurable state-level demonstrations of impact.
Public data on waiver data starting 2028
Paragraph (12) sets forth the information CMS must publish publicly. It includes a description of any limits on the number of individuals who may receive HCBS under a waiver, list availability, eligibility screening, re-screening frequency, and average wait times. It also requires data on the types of services furnished, including average time from approval to service start and the proportion of hours actually furnished, as well as access metrics for homemaker, home health aide, and personal care services. The intention is to create a transparent, comparable data set across states to assess access and performance.
Interim coverage guidance
The Secretary is directed to issue guidance by January 1, 2026 clarifying how a state may provide up to 60 days of HCBS coverage under an interim care plan after eligibility is determined and before a final written plan of care is finalized. This guidance is intended to prevent gaps in service while the formal plan is being developed, thereby smoothing transitions for individuals awaiting ongoing HCBS eligibility determinations.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Individuals with disabilities who qualify under the new waiver pathway and rely on HCBS gain faster access and clearer timelines.
- Elderly Medicaid beneficiaries who depend on HCBS for staying at home rather than entering institutions.
- State Medicaid agencies gain flexibility to align HCBS funding with state needs and streamline planning.
- Home- and community-based service providers (home-care agencies, homemakers, personal care providers) benefit from clearer funding pathways and potential demand for services.
- CMS and state program analysts obtain standardized, publicly available data to monitor access and performance.
- Advocacy groups and researchers can use public data to assess HCBS access and outcomes.
Who Bears the Cost
- States may face higher or differently allocated HCBS expenditures as waivers expand coverage.
- Federal CMS incurs costs related to data hosting, public reporting, and oversight of HCBS waiver programs.
- Providers must invest in compliance and reporting processes to meet new data and documentation requirements.
- Administrative burden may increase for states and providers as new reporting and eligibility criteria are implemented.
- In some cases, funding shifts could require ongoing budget adjustments within state Medicaid programs.
Key Issues
The Core Tension
The central dilemma is balancing expanded, more transparent access to home- and community-based services with the financial and administrative realities of broadening coverage under Medicaid, including achieving timely access without triggering unsustainable cost growth.
The expansion of HCBS waivers and the push for public data collection introduce real policy trade-offs. While increased access to HCBS can reduce costly institutional care and improve quality of life, it also risks higher program costs and operational complexity for states and providers.
The data requirements, while promoting accountability, could reveal wait times or disparities across states that provoke political scrutiny or uneven implementation. The interim-coverage guidance—though designed to prevent gaps—may strain providers who must rapidly adapt to new reporting and coordination obligations from eligibility through plan finalization.
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