Purpose

It is the purpose of this title to require coverage of home and community-based services (in this section referred to as HCBS) under a State plan (or waiver of such plan) under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) for the following reasons: (1) To eliminate waiting lists for HCBS, which delay access to necessary services and deny access to the promise of community inclusion guaranteed under the Americans with Disabilities Act for people with disabilities and older adults. (2) To build on decades of progress in serving people with disabilities and older adults via HCBS. (3) To fulfill the purposes of the Medicaid program to provide medical assistance for those whose income and resources are insufficient to meet the costs of necessary medical services, and to provide rehabilitation, long-term services and supports, and other services to help such families and individuals attain or retain capacity for independence or self-care. (4) To ensure that people with all kinds of disabilities and with multiple disabilities, including intellectual disabilities, cognitive disabilities, developmental disabilities, behavioral health disabilities, physical disabilities, and substance use disorders, and older adults, receive the services they need to live in their communities. (5) To streamline access to HCBS by eliminating the need for States to repeatedly apply for waivers. (6) To continue to increase the capacity of community services to ensure people with disabilities and older adults have high-quality, safe and meaningful options in the community and are not at risk of unnecessary institutionalization. (7) To act on the decades of research and practice that show everyone, including people with the most severe disabilities, can live in the community with the right services and supports. (8) To eliminate the race, gender, sexual orientation, and gender identity disparities that exist in accessing information and HCBS and to prevent the unnecessary impoverishment and institutionalization of black and brown individuals with disabilities and older adults. (9) To support over 63,000,000 unpaid family caregivers, who are disproportionately women, who are often providing complex services and supports to older adults and people with disabilities because of a lack of affordable services, workforce shortages, and other inefficiencies. (10) To improve direct care quality and ensure access to services by improving workforce standards for the nearly 3,200,000 direct care workers—who are primarily women, people of color, and immigrants who face heightened risks of discrimination in employment—providing support to people with disabilities and older adults in their homes and communities.