119-hr4029

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4029 Introduced in House

    (IH) ]

<DOC>

119th CONGRESS
 1st Session
 H. R. 4029

 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

 June 17, 2025

 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 Representatives of the 
United States of America in Congress assembled,

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. 1396d

    (b) ), in the case of an 
 HCBS program State, the Federal medical assistance percentage 
 determined 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 
 percentage 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 2026 and 2027. 
 In no case may the application of the previous sentence result 
 in the Federal 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 services.--The term 
 ``home and community-based services'' means--
            (i) home health care services authorized 
 under paragraph

    (7) of 

section 1905

    (a) of the 
 Social Security Act (42 U.S.C. 1396d

    (a) );
            (ii) behavioral health services authorized 
 under paragraph

    (13) of such section;
            (iii) personal care services authorized 
 under paragraph

    (24) of such section;
            (iv) PACE services authorized under 
 paragraph

    (26) of such section;
            (v) services authorized under subsections

    (b) ,
            (c) ,
            (i) ,

    (j) , and

    (k) of 

section 1915 of 
 such Act (42 U.S.C. 1396n);
            (vi) such services authorized under a 
 waiver under 

section 1115 of such Act (42 
 U.S.C. 1315); and
            (vii) such other services specified by the 
 Secretary.

    (b) Condition.--The condition described in this subsection, 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 addition to such other information as the 
Secretary shall require--

    (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 activities;

    (2) assurances that all Federal funds attributable to the 
 increase under subsection

    (a) will be--
        (A) expended by the State in accordance with this 
 section not later than September 30, 2029; and
        (B) used--
            (i) to implement the activities described 
 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 section; 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 provide home and 
 community-based services to eligible 
 individuals; and

    (3) assurances that the State will conduct adequate 
 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 application 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 improvement.--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 support professionals 
 (including independent providers 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 receives 
 payment under such an increased rate increases the 
 compensation it pays its home health workers or direct 
 support professionals.
        (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 workers and direct 
 support professionals.
            (D) To improve stability of home health worker and 
 direct support professional jobs, including consistent 
 hours, scheduling, pay, and benefit eligibility.
        (E) To provide home and community-based services to 
 eligible individuals who are on waiting lists for 
 programs approved under sections 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 typically 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 conduct home and 
 community-based services.
        (H) To recruit new home health workers and direct 
 support professionals.
            (I) To support family care providers of eligible 
 individuals with needed supplies, equipment, and 
 services, which may include such items as family 
 caregiver pay and respite services.
        (J) To pay for training for home health workers and 
 direct support professionals.
        (K) To pay for assistive technologies, staffing, 
 and training to facilitate eligible individuals' 
 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) .
            (M) To protect the health and safety of home health 
 workers and direct support professionals 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 provide home 
 and community-based services.
        (P) To pay for other expenses deemed appropriate by 
 the Secretary to enhance, expand, or strengthen Home 
 and Community-Based Services, including retainer 
 payments, and expenses 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 (including 
 by paying for moving costs, first month's rent, 
 and other one-time expenses and start-up 
 costs);
            (ii) resuming home and community-based 
 services;
            (iii) receiving mental health services and 
 necessary rehabilitative service to regain 
 skills lost while relocated; and
            (iv) while funds attributable to the 
 increased 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 described in 
 

section 1135

    (g)

    (1)
        (B) of the Social Security 
 Act (42 U.S.C. 1320b-5

    (g)

    (1)
        (B) ).

    (e) Reporting Requirements.--

    (1) State reporting requirements.--Not later than December 
 31, 2029, any State with respect to which an application is 
 approved by the Secretary pursuant to subsection
            (c) shall 
 submit a report to the Secretary that contains the following 
 information:
        (A) Activities and programs that were funded using 
 Federal funds attributable to such increase.
        (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 purposes of 
 subparagraph
        (A) , the external evaluator 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
            (iii) evaluate the implementation and 
 outcomes of this section based on--
            (I) the impact of this section on 
 increasing funding for home and 
 community-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 
 identified 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 

=== findings ===
-The 
 Secretary shall--
            (i) disseminate the findings from the 
 evaluations conducted under this paragraph to--
            (I) all State Medicaid directors; 
 and
            (II) the Committee on Energy and 
 Commerce of the House of 
 Representatives, the Committee on 
 Finance of the Senate, and the Special 
 Committee on Aging of the Senate; and
            (ii) make all evaluation findings publicly 
 available in an accessible electronic format 
 and any other accessible format determined 
 appropriate by the Secretary.
            (D) Oversight.--Each State with respect to which an 
 application is approved by the Secretary pursuant to 
 subsection
            (c) shall ensure adequate oversight of the 
 expenditure of Federal funds pursuant to such increase 
 in accordance with the Medicaid regulations, including 
 

section 1115 and 1915 waiver regulations and special 
 terms and conditions for any relevant waiver or grant 
 program.

    (3) Non-application of the paperwork reduction act.--
 Chapter 35 of title 44, United States Code (commonly referred 
 to as the ``Paperwork 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 Medicaid program.

    (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 meaning given such 
 term for purposes of title XIX of the Social Security Act (42 
 U.S.C. 1396 et seq.).
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