Sec. 102. Additional support for Medicaid long-term care services and direct care professionals
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Not later than 18 months after the date of enactment of this Act, the Secretary of Health and Human Services (referred to in this section as the Secretary ) shall award grants to States for the purpose of supporting and strengthening services provided by direct care professionals across direct care settings and improving recruitment, compensation, and retention of the direct care professional workforce. Not later than 6 months after the date of enactment of this Act, each State that seeks to receive a grant under this section shall submit an application, in such form and manner as the Secretary shall require, to the Secretary that includes— information on how the State will use grant funds to improve long-term care services and the recruitment, compensation, and retention of direct care professionals in a manner that maximizes the independence of people with disabilities and older individuals, limits unnecessary institutionalization, and supports people living in residential settings; specifies the proportion of grant funds that the State plans to spend on activities to support long-term professional care workers in nursing homes, home health settings, and home and community-based services settings, respectively; a plan for sustaining the work at the conclusion of the grant period; and such other information as the Secretary shall require.
The Secretary shall award each State that submits an application to the Secretary that meets the requirements of subsection
(b)a 5-year grant in an amount that bears the same proportion to the amount appropriated under subsection
(e)as— the number of individuals who are enrolled for medical assistance under the Medicaid program of the State involved (as determined by the Secretary using the most recent data available as of the date of enactment of this Act); bears to the total number of individuals who are enrolled for medical assistance under the Medicaid programs of all States that submit to the Secretary an application that meets the requirements of subsection (b). A State that receives a grant under this section shall use the funds of such grant in accordance with the requirements of this subsection. A State shall use funds from a grant awarded under this section to supplement, and not supplant, the level of State funds expended for services in long-term care settings through programs in effect as of January 1, 2026. The State shall use funds from a grant awarded under this section to implement and evaluate, or supplement the implementation of, activities (which shall include the activities described in paragraph (4)) to enhance, expand, or strengthen long-term care services and to improve compensation to the workforce that provides such services. The State strengthens and expands the direct care professional workforce that provides services across long-term care settings by— adopting a salary review process to ensure that the rates payable for long-term care services under the State Medicaid program are sufficient to ensure access to such services under such program; requiring that a percentage of all payments for long-term care services that are made under the State Medicaid program, including base payments and supplemental payments, improve compensation, benefits, working conditions, and training for direct care professionals and direct care managers; and updating, developing, and adopting qualification standards and training opportunities for the continuum of direct care professionals, including programs for independent direct care professionals and agency direct care professionals, as well as unique programs. In carrying out subparagraph (A)(i), the State shall— address insufficient payment rates under the State Medicaid program for delivery of long-term care services with an emphasis on supporting the recruitment and retention of direct care professionals; update payment rates under the State Medicaid program for long-term care services, including home and community-based services, nursing home services, skilled nursing facility services, and intermediate care facility services at least every 2 years through a transparent process involving meaningful input from stakeholders, in which the majority of stakeholders are recipients of such services, families, direct care professionals, family caregivers, chosen representatives of direct care workers, aging, disability, and workforce advocates, long-term care providers, and may also include health plans; and ensure that, with respect to any increases in the payment rates under the State Medicaid program for long-term care services— at a minimum, increases in the payment rates for long-term care services are proportionately passed through to direct care professionals and direct care professional managers who provide such services and in a manner that is determined with input from the stakeholders described in clause (ii); such payment rate increases are incorporated into payment rates for such services provided under title XIX of the Social Security Act ( 42 U.S.C. 1396 et seq. ) by a managed care entity (as defined in section 1932(a)(1)(B) of the Social Security Act ( 42 U.S.C. 1396u–2(a)(1)(B) ) or a prepaid inpatient health plan or prepaid ambulatory health plan, as defined in section 438.2 of title 42, Code of Federal Regulations (or any successor regulation)), under a contract with the State; such payment rate increases are appropriately distributed across settings, populations, and services so as to promote independence of people with disabilities and older individuals, not result in increased institutionalization, and assists in the facilitation of rebalancing the Medicaid program towards the least restrictive settings appropriate for individuals receiving services; and such payment rate increases are prioritized toward home and community-based service workers in States that have a waiting list for home and community based services and have been determined by the Centers for Medicare & Medicaid Service to have inadequate capacity for such services. There is appropriated to the Secretary for awarding grants under this section an amount equal to $100,000,000,000. The Secretary shall evaluate the implementation and outcomes of this title on State Medicaid program waiting lists for home and community-based services through a contract with an external evaluator who has experience with evaluation related to people with disabilities and older individuals.
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- 42 USC 1396u–2(a)(1)(B)
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Sec. 102
Additional support for Medicaid long-term care services and direct care professionals
Cite42 USC 1396u–2(a)(1)(B)
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