II 

118TH CONGRESS 

1ST SESSION S. 3118 

To provide for an emergency increase in Federal funding to State Medicaid 

programs for expenditures on home and community-based services. 

IN THE SENATE OF THE UNITED STATES 

OCTOBER 24, 2023 

Mr. CASEY (for himself, Mr. MERKLEY, Ms. DUCKWORTH, Ms. SMITH, Mr. 

BLUMENTHAL, Mr. REED, Ms. BALDWIN, Mrs. GILLIBRAND, Mr. SANDERS, Ms. WARREN, Ms. STABENOW, Mr. WHITEHOUSE, Mr. BOOKER, 

Mr. WELCH, Mr. KAINE, Ms. KLOBUCHAR, Mr. FETTERMAN, Mr. VAN

HOLLEN, Mr. MARKEY, Mr. HEINRICH, and Mr. WYDEN) introduced the 

following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To provide for an emergency increase in Federal funding 

to State Medicaid programs for expenditures on home 

and community-based services. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘HCBS Relief Act of 

5 2023’’. 


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1 SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND 

2 COMMUNITY-BASED SERVICES. 

3 (a) INCREASED FMAP.— 

4 (1) IN GENERAL.—Notwithstanding section 

5 1905(b) of the Social Security Act (42 U.S.C. 

6 1396d(b)), in the case of an HCBS program State, 

7 the Federal medical assistance percentage deter8 mined for the State under section 1905(b) of such 

9 Act and, if applicable, increased under subsection 

10 (y), (z), or (aa) of section 1905 of such Act (42 

11 U.S.C. 1396d), or section 1915(k) of such Act (42 

12 U.S.C. 1396n(k)), shall be increased by 10 percent13 age points with respect to expenditures of the State 

14 under the State Medicaid program for home and 

15 community-based services that are provided during 

16 fiscal years 2024 and 2025. In no case may the ap17 plication of the previous sentence result in the Fed18 eral medical assistance percentage determined for a 

19 State being more than 95 percent. 

20 (2) DEFINITIONS.—In this section: 

21 (A) HCBS PROGRAM STATE.—The term 

22 ‘‘HCBS program State’’ means a State that 

23 meets the condition described in subsection (b) 

24 by submitting an application described in such 

25 subsection, which is approved by the Secretary 

26 pursuant to subsection (c). 


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1 (B) HOME AND COMMUNITY-BASED SERV2 ICES.—The term ‘‘home and community-based 

3 services’’ means home health care services au4 thorized under paragraph (7) of section 1905(a) 

5 of the Social Security Act (42 U.S.C. 

6 1396d(a)), behavioral health services authorized 

7 under paragraph (13) of such section, personal 

8 care services authorized under paragraph (24) 

9 of such section, PACE services authorized 

10 under paragraph (26) of such section, services 

11 authorized under subsections (b), (c), (i), (j), 

12 and (k) of section 1915 of such Act (42 U.S.C. 

13 1396n), such services authorized under a waiver 

14 under section 1115 of such Act (42 U.S.C. 

15 1315), and such other services specified by the 

16 Secretary. 

17 (b) CONDITION.—The condition described in this sub18 section, with respect to a State, is that the State submits 

19 an application to the Secretary, at such time and in such 

20 manner as specified by the Secretary, that includes, in ad21 dition to such other information as the Secretary shall re22 quire— 

23 (1) a description of which activities described in 

24 subsection (d) that a State plans to implement and 


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1 a description of how it plans to implement such ac2 tivities; 

3 (2) assurances that all Federal funds attrib4 utable to the increase under subsection (a) will be— 

5 (A) expended by the State in accordance 

6 with this section not later than September 30, 

7 2027; and 

8 (B) used— 

9 (i) to implement the activities de10 scribed in subsection (d); 

11 (ii) to supplement, and not supplant, 

12 the level of State funds expended for home 

13 and community-based services for eligible 

14 individuals through programs in effect as 

15 of the date of the enactment of this sec16 tion; and 

17 (iii) to increase reimbursement rates 

18 for home and community-based services to 

19 a level that will support recruitment and 

20 retention of a sufficient workforce to pro21 vide home and community-based services 

22 to eligible individuals; and 

23 (3) assurances that the State will conduct ade24 quate oversight and ensure the validity of such data 

25 as may be required by the Secretary. 


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1 (c) APPROVAL OF APPLICATION.—Not later than 90 

2 days after the date of submission of an application of a 

3 State under subsection (b), the Secretary shall certify if 

4 the application is complete. Upon certification that an ap5 plication of a State is complete, the application shall be 

6 deemed to be approved for purposes of this section. 

7 (d) ACTIVITIES TO IMPROVE THE DELIVERY OF

8 HCBS.— 

9 (1) IN GENERAL.—A State shall work with 

10 community partners, such as Area Agencies on 

11 Aging, Centers for Independent Living, non-profit 

12 home and community-based services providers, and 

13 other entities providing home and community-based 

14 services, to implement the purposes described in 

15 paragraph (2). 

16 (2) FOCUSED AREAS OF HCBS IMPROVE17 MENT.—The purposes described in this paragraph, 

18 with respect to a State, are the following: 

19 (A) To increase rates for home health 

20 agencies and agencies that employ direct sup21 port professionals (including independent pro22 viders in a self-directed or consumer-directed 

23 model) to provide home and community-based 

24 services under the State Medicaid program, 

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1 ceives payment under such an increased rate in2 creases the compensation it pays its home 

3 health workers or direct support professionals. 

4 (B) To provide paid sick leave, paid family 

5 leave, and paid medical leave for home health 

6 workers and direct support professionals. 

7 (C) To provide hazard pay, overtime pay, 

8 and shift differential pay for home health work9 ers and direct support professionals. 

10 (D) To improve stability of home health 

11 worker and direct support professional jobs, in12 cluding consistent hours, scheduling, pay, and 

13 benefit eligibility. 

14 (E) To provide home and community-based 

15 services to eligible individuals who are on wait16 ing lists for programs approved under sections 

17 1115 or 1915 of the Social Security Act (42 

18 U.S.C. 1315, 1396n). 

19 (F) To purchase emergency supplies and 

20 equipment, which may include items not typi21 cally covered under the Medicaid program, such 

22 as personal protective equipment, necessary to 

23 enhance access to services and to protect the 

24 health and well-being of home health workers 

25 and direct support professionals. 


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1 (G) To pay for the travel of home health 

2 workers and direct support professionals to con3 duct home and community-based services. 

4 (H) To recruit new home health workers 

5 and direct support professionals. 

6 (I) To support family care providers of eli7 gible individuals with needed supplies, equip8 ment, and services, which may include such 

9 items as family caregiver pay and respite serv10 ices. 

11 (J) To pay for training for home health 

12 workers and direct support professionals. 

13 (K) To pay for assistive technologies, staff14 ing, and training to facilitate eligible individ15 uals’ communication, and other costs incurred 

16 in order to facilitate community integration and 

17 ensure an individual’s person-centered service 

18 plan continues to be fully implemented. 

19 (L) To prepare information and public 

20 health and educational materials in accessible 

21 formats (including formats accessible to people 

22 with low literacy or intellectual disabilities) 

23 about prevention, treatment, recovery and other 

24 aspects of communicable diseases and threats to 

25 the health of eligible individuals, their families, 


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1 and the general community served by agencies 

2 described in subparagraph (A). 

3 (M) To protect the health and safety of 

4 home health workers and direct support profes5 sionals during public health emergencies and 

6 natural disasters. 

7 (N) To pay for interpreters to assist in 

8 providing home and community-based services 

9 to eligible individuals and to inform the general 

10 public about communicable diseases and other 

11 public health threats. 

12 (O) To allow day services providers to pro13 vide home and community-based services. 

14 (P) To pay for other expenses deemed ap15 propriate by the Secretary to enhance, expand, 

16 or strengthen Home and Community-Based 

17 Services, including retainer payments, and ex18 penses which meet the criteria of the home and 

19 community-based settings rule published on 

20 January 16, 2014. 

21 (Q) To assist eligible individuals who had 

22 to relocate to a nursing facility or institutional 

23 setting from their homes in— 

24 (i) moving back to their homes (in25 cluding by paying for moving costs, first 


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1 month’s rent, and other one-time expenses 

2 and start-up costs); 

3 (ii) resuming home and community4 based services; 

5 (iii) receiving mental health services 

6 and necessary rehabilitative service to re7 gain skills lost while relocated; and 

8 (iv) while funds attributable to the in9 creased FMAP under this section remain 

10 available, continuing home and community11 based services for eligible individuals who 

12 were served from a waiting list for such 

13 services during the emergency period de14 scribed in section 1135(g)(1)(B) of the So15 cial Security Act (42 U.S.C. 1320b– 

16 5(g)(1)(B)). 

17 (e) REPORTING REQUIREMENTS.— 

18 (1) STATE REPORTING REQUIREMENTS.—Not 

19 later than December 31, 2027, any State with re20 spect to which an application is approved by the Sec21 retary pursuant to subsection (c) shall submit a re22 port to the Secretary that contains the following in23 formation: 


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1 (A) Activities and programs that were 

2 funded using Federal funds attributable to such 

3 increase. 

4 (B) The number of eligible individuals who 

5 were served by such activities and programs. 

6 (C) The number of eligible individuals who 

7 were able to resume home and community8 based services as a result of such activities and 

9 programs. 

10 (2) HHS EVALUATION.— 

11 (A) IN GENERAL.—The Secretary shall 

12 evaluate the implementation and outcomes of 

13 this section in the aggregate using an external 

14 evaluator with experience evaluating home and 

15 community-based services, disability programs, 

16 and older adult programs. 

17 (B) EVALUATION CRITERIA.—For pur18 poses of subparagraph (A), the external eval19 uator shall— 

20 (i) document and evaluate changes in 

21 access, availability, and quality of home 

22 and community-based services in each 

23 HCBS program State; 

24 (ii) document and evaluate aggregate 

25 changes in access, availability, and quality 


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1 of home and community-based services 

2 across all such States; and 

3 (iii) evaluate the implementation and 

4 outcomes of this section based on— 

5 (I) the impact of this section on 

6 increasing funding for home and com7 munity-based services; 

8 (II) the impact of this section on 

9 achieving targeted access, availability, 

10 and quality of home and community11 based services; and 

12 (III) promising practices identi13 fied by activities conducted pursuant 

14 to subsection (d) that increase access 

15 to, availability of, and quality of home 

16 and community-based services. 

17 (C) DISSEMINATION OF EVALUATION FIND18 INGS.—The Secretary shall— 

19 (i) disseminate the findings from the 

20 evaluations conducted under this para21 graph to— 

22 (I) all State Medicaid directors; 

23 and 

24 (II) the Committee on Energy 

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1 resentatives, the Committee on Fi2 nance of the Senate, and the Special 

3 Committee on Aging of the Senate; 

4 and 

5 (ii) make all evaluation findings pub6 licly available in an accessible electronic 

7 format and any other accessible format de8 termined appropriate by the Secretary. 

9 (D) OVERSIGHT.—Each State with respect 

10 to which an application is approved by the Sec11 retary pursuant to subsection (c) shall ensure 

12 adequate oversight of the expenditure of Fed13 eral funds pursuant to such increase in accord14 ance with the Medicaid regulations, including 

15 section 1115 and 1915 waiver regulations and 

16 special terms and conditions for any relevant 

17 waiver or grant program. 

18 (3) NON-APPLICATION OF THE PAPERWORK RE19 DUCTION ACT.—Chapter 35 of title 44, United 

20 States Code (commonly referred to as the ‘‘Paper21 work Reduction Act of 1995’’), shall not apply to the 

22 provisions of this subsection. 

23 (f) ADDITIONAL DEFINITIONS.—In this section: 

24 (1) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 

25 individual’’ means an individual who is eligible for or 


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1 enrolled for medical assistance under a State Med2 icaid program. 

3 (2) MEDICAID PROGRAM.—The term ‘‘Medicaid 

4 program’’ means, with respect to a State, the State 

5 program under title XIX of the Social Security Act 

6 (42 U.S.C. 1396 et seq.) (including any waiver or 

7 demonstration under such title or under section 

8 1115 of such Act (42 U.S.C. 1315) relating to such 

9 title). 

10 (3) SECRETARY.—The term ‘‘Secretary’’ means 

11 the Secretary of Health and Human Services. 

12 (4) STATE.—The term ‘‘State’’ has the mean13 ing given such term for purposes of title XIX of the 

14 Social Security Act (42 U.S.C. 1396 et seq.). 

Æ 


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