Medicaid would cover home care for people who qualify

States would have to cover home and community care for Medicaid members who meet the care eligibility rules and choose it. One way to qualify would require an approved provider to find an impairment expected to last at least 90 days, assessed without counting help already received. That impairment would have to prevent someone from doing at least two daily living or household tasks without help. Medicaid members under 21 would also qualify. Before the required coverage start date, people receiving or approved for these services at enactment could qualify while still meeting their program's care rules. Required coverage would start on the first day of the first calendar quarter beginning on or after five years after enactment. States could start earlier.

States would have to provide a Medicaid eligibility path for people who meet the home care rules and income limit. This path would cover people meeting the home care eligibility rules who do not qualify under an earlier listed Medicaid category. Income could not exceed the higher of 150 percent of the poverty line for the person's family size or 300 percent of the federal Supplemental Security Income benefit rate. States could also cover people above that threshold but below a state-set income limit. The required eligibility path would start with the first calendar quarter beginning on or after five years after enactment. States could start earlier.

The federal government would pay the full cost of most covered home and community care if states meet service requirements. Covered services would include care provided under Medicaid waivers, which let states use approved alternatives to regular program rules. States would have to strengthen services and access, including ensuring that payment rate increases reach direct care workers at least proportionately. The full federal payment rate would exclude people eligible only through a state's optional higher-income home care path. The full federal payment rate would apply to covered services furnished on or after enactment.

States could not collect repayment for Medicaid care that was correctly paid. The rule would cover Medicaid benefits generally, beyond home and community care. The prohibition would apply to correctly paid benefits. The collection ban would apply on or after enactment. States would have 90 days to withdraw related legal claims against property and notify people or their representatives.

Federal grants would support care worker careers and family caregivers if Congress provides funding. Projects could support care workers and paid or unpaid family caregivers. The bill would authorize $1 billion for grants for fiscal year 2029. Congress would still need to provide that money. Grant recipients would have to spend at least five percent on financial help or support services for participants during project activities. Money provided for these grants would remain available until September 30, 2038.