This bill makes changes to Medicaid to help more people get home and community-based services—things like help with cleaning, cooking, personal care, and other support that allows people to live in their homes instead of institutions. Right now, Medicaid only covers these services for people who meet very specific eligibility requirements. This bill lets states expand coverage to include people with disabilities who don't meet those strict requirements, as long as the state can prove that helping these new people won't slow down services for those already approved.

The bill also requires much better transparency about how these services actually work. Starting in 2028, states must publicly report detailed information about their waiting lists—how many people are waiting, how long they wait, and whether people on the list are regularly checked to see if they've become eligible. States also have to report how quickly people actually start receiving services once approved, and whether they're getting the full hours of care that were authorized for them. This transparency helps the public and policymakers see if the system is working well or if there are problems with delays and gaps in service.

Additionally, the bill gives states flexibility to provide up to 60 days of temporary care services while a person's full care plan is being finalized, so people don't have to wait without any support once they're determined to be eligible. Overall, the bill aims to expand who can access these important services while making sure the system is honest about how well it's actually serving people.