HAA: S5320 and H.R.8540
MHA: S5270 and H.R.10020
There are several bills related to community services that are currently in Congress, and others that have been proposed. All provide protection from unwanted institutionalization, either in theory, or practically and coupled with funding.
Because we in ADAPT have received requests for more information about why we support HAA and MHA specifically, here is a start;
During the “good old days” of the Biden Administration and before the “Big Bill” (HR 1) passed in May 2025 making serious cuts to Medicaid and Medicaid eligibility, along with other cuts to health and disability programs, this was the HCBS landscape:
1. Each state was operating multiple programs. Each program had its own specific eligibility criteria, its own funding, and was subject to state budget battles. All of these elements were subject to change by each State with little or no notice.
2. There was a wide variation between and across States in eligibility, type and amounts of services, budgeting, support for families, treatment of workers, etc. If you moved from one state to another, there was no guarantee your services from the first state would be covered by your new state.
3. There was and continues to be a national workforce crisis including paid and unpaid family caregivers, again varying from state to state in specifics
4. There was and continues to be a national housing crisis, both because of affordability in general and the lack of affordable, accessible community housing.
5. We have long seen significant disparate impacts in quality, availability and outcomes for People of Color in all long-term care services and supports, including in HCBS.
6. Indigenous People have 20 year lower life expectancy, yet in many rural, frontier and Sovereign tribal lands HCBS is not even available.
(Note: Pres. Biden was just beginning to address this and collect data, but that stopped after the election of the current administration.)
7. There were 600,000+ disabled and older people on waitlists for services.
After $1.4 trillion in cuts by the Trump administration, does anyone think the situation is better? Or that this deplorable situation can be addressed without substantial funding and program reform? We demand these inequities -social, racial, geographic – be fixed. We want more than an affirmation of a right we already have to a system that has now been sliced and diced and stripped of funding and burdened with a new layer of oppressive rules.
Attempts to make this mess better by simply reaffirming rights we already have with no programmatic reforms or needed funding could make things worse by intensifying a “hunger games” approach for whoever qualifies for ever-changing institutional eligibility on a State by State basis, all while fixable discrimination rolls on. Without concrete reform, each individual State will continue to control the size and nature of HCBS through their state constitutional budgetary authority. Citizens cannot sue their State over budget decisions due to sovereignty, and many States cap any possible damages at very low amounts.
Rights to sue will not solve these giant issues. We need reform and we need financing. This is why ADAPT’s priorities are the HCBS ACCESS Act and the Medicare at Home Act, where we will direct our efforts, and where we encourage you to direct yours.