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HCBS ACCESS ACT: Input Requested!

Monday, April 5, 2021

There is a lot going on in our nation's Capitol right now as well.  Iowa is represented by seven people in the United State Congress - two US Senators representing all of Iowa, and five US Representatives who each represent a different part of Iowa. They have been busy at work with COVID-19 response and their own budget-setting process.  A group of federal legislators from other states have started working on an exciting new bill to expand access to home and community based services (commonly called HCBS), a proposal they are calling the HCBS Access Act. 

Many people do not realize that services that help people stay in their own homes and communities are currently optional services that state Medicaid programs can provide. They are not required, so states wanting to provide these less expensive, higher demand services through a waiver process that allows waiting lists to be created if the state does not budget enough funds to meet demand for the services.  Iowa currently has more than 15,000 people on its combined HCBS waiver waiting list. 

In fact, Medicaid is only required to pay for institutional services like those in nursing homes, mental health institutes, and state resource centers without waiting lists. This has not changed since Medicaid was first created by Congress in 1965, when institutionalization was the only option for people with disabiities.  Thank goodness times have changed, but the federal law has not changed with the times.  That is why lead sponsors Senator Sherrod Brown (D-Ohio), Senator Margaret Wood Hassan (D-New Hampshire), Senator Robert Casey (D-Pennsylvania) and Representative Debbie Dingell (D-Michigan) are working on the HCBS Access Act and are asking for input from stakeholders like you! 

The proposal upends Medicaid, making HCBS services mandatory and eliminating waiting lists for these important, less costly services.  The Act would also permanently increase Medicaid funding for HCBS, and provide additional grant funding to help states build the capacity to serve all people who need HCBS. Sponsors hope the changes proposed will also improve the quality of the direct care workforce and address the decades-long workforce crisis by ensuring that the workers that support people with disabilies and older adults (who are disproportionately women of color) are fairly paid.  These changes will also allow people with disabilities and their families to move from state-to-state and still be able to access crucial HCBS services. Finally, the Act will provide the federal Medicaid resources necessary to fulfill the promises of the Americans with Disabilies Act and the Supreme Court’s Olmstead decision so that people with disabilies and older adults can live the lives they want in their homes and communities.

  • Click here for a one-pager on the HCBS Access Act.
  • Click here for the request for comment from the Act's lead sponsors (due April 26).
  • Click here to read the proposed bill language (they will introduce after reviewing comments and making changes).
  • Click here for the Iowa Disability League's Facebook Live HCBS Access Act Discussion. 
  • Click here for notes on the "good" and "bad" parts of the bill (from advocates on the Facebook Live discussion).

The Iowa Disability League is hosting a follow-up Zoom conversation on the HCBS Access Act on Tuesday, April 20 at 6:00 p.m. to collectively review areas of concern in the HCBS Access Act draft, discuss changes, and then take action together.  To participate you will need to pre-register here.  Captioning will be provided (checking on funding for ASL) so please request so we can make sure it is available. Contact Jenn Wolff, justjennot@gmail.com with any questions.



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