I 
118TH CONGRESS 
1ST SESSION H. R. 6296 
To provide for an emergency increase in Federal funding to State Medicaid 
programs for expenditures on home and community-based services. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 8, 2023 
Mrs. DINGELL introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
To provide for an emergency increase in Federal funding 
to State Medicaid programs for expenditures on home 
and community-based services. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘HCBS Relief Act of 
2023’’. 
SEC. 2. ADDITIONAL SUPPORT FOR MEDICAID HOME AND 
COMMUNITY-BASED SERVICES. 
(a) INCREASED FMAP.— 
(1) IN
GENERAL.—Notwithstanding section 
1905(b) of the Social Security Act (42 U.S.C. 
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1396d(b)), in the case of an HCBS program State, 
the Federal medical assistance percentage deter-
mined for the State under section 1905(b) of such 
Act and, if applicable, increased under subsection 
(y), (z), or (aa) of section 1905 of such Act (42 
U.S.C. 1396d), or section 1915(k) of such Act (42 
U.S.C. 1396n(k)), shall be increased by 10 percent-
age points with respect to expenditures of the State 
under the State Medicaid program for home and 
community-based services that are provided during 
fiscal years 2024 and 2025. In no case may the ap-
plication of the previous sentence result in the Fed-
eral medical assistance percentage determined for a 
State being more than 95 percent. 
(2) DEFINITIONS.—In this section: 
(A) HCBS PROGRAM
STATE.—The term 
‘‘HCBS program State’’ means a State that 
meets the condition described in subsection (b) 
by submitting an application described in such 
subsection, which is approved by the Secretary 
pursuant to subsection (c). 
(B) HOME AND COMMUNITY-BASED SERV-
ICES.—The term ‘‘home and community-based 
services’’ means home health care services au-
thorized under paragraph (7) of section 1905(a) 
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of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1396d(a)), behavioral health services authorized 
under paragraph (13) of such section, personal 
care services authorized under paragraph (24) 
of such section, PACE services authorized 
under paragraph (26) of such section, services 
authorized under subsections (b), (c), (i), (j), 
and (k) of section 1915 of such Act (42 U.S.C. 
1396n), such services authorized under a waiver 
under section 1115 of such Act (42 U.S.C. 
1315), and such other services specified by the 
Secretary. 
(b) CONDITION.—The condition described in this sub-
section, with respect to a State, is that the State submits 
an application to the Secretary, at such time and in such 
manner as specified by the Secretary, that includes, in ad-
dition to such other information as the Secretary shall re-
quire— 
(1) a description of which activities described in 
subsection (d) that a State plans to implement and 
a description of how it plans to implement such ac-
tivities; 
(2) assurances that all Federal funds attrib-
utable to the increase under subsection (a) will be— 
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(A) expended by the State in accordance 
with this section not later than September 30, 
2027; and 
(B) used— 
(i) to implement the activities de-
scribed in subsection (d); 
(ii) to supplement, and not supplant, 
the level of State funds expended for home 
and community-based services for eligible 
individuals through programs in effect as 
of the date of the enactment of this sec-
tion; and 
(iii) to increase reimbursement rates 
for home and community-based services to 
a level that will support recruitment and 
retention of a sufficient workforce to pro-
vide home and community-based services 
to eligible individuals; and 
(3) assurances that the State will conduct ade-
quate oversight and ensure the validity of such data 
as may be required by the Secretary. 
(c) APPROVAL OF APPLICATION.—Not later than 90 
days after the date of submission of an application of a 
State under subsection (b), the Secretary shall certify if 
the application is complete. Upon certification that an ap-
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plication of a State is complete, the application shall be 
deemed to be approved for purposes of this section. 
(d) ACTIVITIES TO IMPROVE
THE DELIVERY
OF 
HCBS.— 
(1) IN
GENERAL.—A State shall work with 
community partners, such as Area Agencies on 
Aging, Centers for Independent Living, non-profit 
home and community-based services providers, and 
other entities providing home and community-based 
services, to implement the purposes described in 
paragraph (2). 
(2) FOCUSED
AREAS
OF
HCBS
IMPROVE-
MENT.—The purposes described in this paragraph, 
with respect to a State, are the following: 
(A) To increase rates for home health 
agencies and agencies that employ direct sup-
port professionals (including independent pro-
viders in a self-directed or consumer-directed 
model) to provide home and community-based 
services under the State Medicaid program, 
provided that any agency or individual that re-
ceives payment under such an increased rate in-
creases the compensation it pays its home 
health workers or direct support professionals. 
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(B) To provide paid sick leave, paid family 
leave, and paid medical leave for home health 
workers and direct support professionals. 
(C) To provide hazard pay, overtime pay, 
and shift differential pay for home health work-
ers and direct support professionals. 
(D) To improve stability of home health 
worker and direct support professional jobs, in-
cluding consistent hours, scheduling, pay, and 
benefit eligibility. 
(E) To provide home and community-based 
services to eligible individuals who are on wait-
ing lists for programs approved under section 
1115 or 1915 of the Social Security Act (42 
U.S.C. 1315, 1396n). 
(F) To purchase emergency supplies and 
equipment, which may include items not typi-
cally covered under the Medicaid program, such 
as personal protective equipment, necessary to 
enhance access to services and to protect the 
health and well-being of home health workers 
and direct support professionals. 
(G) To pay for the travel of home health 
workers and direct support professionals to con-
duct home and community-based services. 
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(H) To recruit new home health workers 
and direct support professionals. 
(I) To support family care providers of eli-
gible individuals with needed supplies, equip-
ment, and services, which may include items 
such as family caregiver pay and respite serv-
ices. 
(J) To pay for training for home health 
workers and direct support professionals. 
(K) To pay for assistive technologies, staff-
ing, training to facilitate an eligible individual’s 
communication, and other costs incurred in 
order to facilitate community integration and 
ensure an individual’s person-centered service 
plan continues to be fully implemented. 
(L) To prepare information and public 
health and educational materials in accessible 
formats (including formats accessible to people 
with low literacy or intellectual disabilities) 
about prevention, treatment, recovery and other 
aspects of communicable diseases and threats to 
the health of eligible individuals, their families, 
and the general community served by agencies 
described in subparagraph (A). 
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(M) To protect the health and safety of 
home health workers and direct support profes-
sionals during public health emergencies and 
natural disasters. 
(N) To pay for interpreters to assist in 
providing home and community-based services 
to eligible individuals and to inform the general 
public about communicable diseases and other 
public health threats. 
(O) To allow day services providers to pro-
vide home and community-based services. 
(P) To pay for other expenses deemed ap-
propriate by the Secretary to enhance, expand, 
or strengthen Home and Community-Based 
Services, including retainer payments, and ex-
penses which meet the criteria of the home and 
community-based settings rule published on 
January 16, 2014. 
(Q) To assist eligible individuals who had 
to relocate to a nursing facility or institutional 
setting from their homes in— 
(i) moving back to their homes (in-
cluding by paying for moving costs, first 
month’s rent, and other one-time expenses 
and start-up costs); 
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(ii) resuming home and community- 
based services; 
(iii) receiving mental health services 
and necessary rehabilitative service to re-
gain skills lost while relocated; and 
(iv) while funds attributable to the in-
creased FMAP under this section remain 
available, continuing home and community- 
based services for eligible individuals who 
were served from a waiting list for such 
services during the emergency period de-
scribed in section 1135(g)(1)(B) of the So-
cial Security Act (42 U.S.C. 1320b– 
5(g)(1)(B)). 
(e) REPORTING REQUIREMENTS.— 
(1) STATE
REPORTING
REQUIREMENTS.—Not 
later than December 31, 2027, any State with re-
spect to which an application is approved by the Sec-
retary pursuant to subsection (c) shall submit a re-
port to the Secretary that contains the following in-
formation: 
(A) Activities and programs that were 
funded using Federal funds attributable to such 
increase. 
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(B) The number of eligible individuals who 
were served by such activities and programs. 
(C) The number of eligible individuals who 
were able to resume home and community- 
based services as a result of such activities and 
programs. 
(2) HHS EVALUATION.— 
(A) IN
GENERAL.—The Secretary shall 
evaluate the implementation and outcomes of 
this section in the aggregate using an external 
evaluator with experience evaluating home and 
community-based services, disability programs, 
and older adult programs. 
(B) EVALUATION
CRITERIA.—For pur-
poses of subparagraph (A), the external eval-
uator shall— 
(i) document and evaluate changes in 
access, availability, and quality of home 
and community-based services in each 
HCBS program State; 
(ii) document and evaluate aggregate 
changes in access, availability, and quality 
of home and community-based services 
across all such States; and 
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(iii) evaluate the implementation and 
outcomes of this section based on— 
(I) the impact of this section on 
increasing funding for home and com-
munity-based services; 
(II) the impact of this section on 
achieving targeted access, availability, 
and quality of home and community- 
based services; and 
(III) promising practices identi-
fied by activities conducted pursuant 
to subsection (d) that increase access 
to, availability of, and quality of home 
and community-based services. 
(C) DISSEMINATION OF EVALUATION FIND-
INGS.—The Secretary shall— 
(i) disseminate the findings from the 
evaluations conducted under this para-
graph to— 
(I) all State Medicaid directors; 
and 
(II) the Committee on Energy 
and Commerce of the House of Rep-
resentatives, the Committee on Fi-
nance of the Senate, and the Special 
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Committee on Aging of the Senate; 
and 
(ii) make all evaluation findings pub-
licly available in an accessible electronic 
format and any other accessible format de-
termined appropriate by the Secretary. 
(D) OVERSIGHT.—Each State with respect 
to which an application is approved by the Sec-
retary pursuant to subsection (c) shall ensure 
adequate oversight of the expenditure of Fed-
eral funds pursuant to such increase in accord-
ance with the Medicaid regulations, including 
sections 1115 and 1915 waiver regulations and 
special terms and conditions for any relevant 
waiver or grant program. 
(3) NON-APPLICATION OF THE PAPERWORK RE-
DUCTION
ACT.—Chapter 35 of title 44, United 
States Code (commonly referred to as the ‘‘Paper-
work Reduction Act of 1995’’), shall not apply to the 
provisions of this subsection. 
(f) ADDITIONAL DEFINITIONS.—In this section: 
(1) ELIGIBLE INDIVIDUAL.—The term ‘‘eligible 
individual’’ means an individual who is eligible for or 
enrolled for medical assistance under a State Med-
icaid program. 
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(2) MEDICAID PROGRAM.—The term ‘‘Medicaid 
program’’ means, with respect to a State, the State 
program under title XIX of the Social Security Act 
(42 U.S.C. 1396 et seq.) (including any waiver or 
demonstration under such title or under section 
1115 of such Act (42 U.S.C. 1315) relating to such 
title). 
(3) SECRETARY.—The term ‘‘Secretary’’ means 
the Secretary of Health and Human Services. 
(4) STATE.—The term ‘‘State’’ has the mean-
ing given such term for purposes of title XIX of the 
Social Security Act (42 U.S.C. 1396 et seq.). 
Æ 
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