Washington, D.C. — A federal protection that was supposed to give Medicaid beneficiaries a way to fight back when their home care plans fall through won’t be enforced for another year and a half. The Centers for Medicare and Medicaid Services announced it’s exercising enforcement discretion on a key provision of its 2024 Access Rule — pushing the effective compliance deadline to December 31, 2027.
The delay affects the grievance system requirement, one of the centerpieces of the “Ensuring Access to Medicaid Services” rule finalized under the Biden administration. Under that rule, states were required to build a formal complaint process so that traditional Medicaid beneficiaries could file grievances when they couldn’t access the home and community-based services written into their care plans. The original deadline was July 9, 2026.
Why States Pushed Back
CMS deputy administrator Dan Brillman acknowledged the situation in a recent bulletin, noting that a number of states told the agency they simply couldn’t meet the deadline. The main sticking point: building or updating electronic systems to handle complaints and integrate with incident management databases.
“Some states have indicated that they will be unable to meet the July 9, 2026 applicability date…at least in part because of the time required to implement changes to existing electronic systems,” Brillman wrote. The agency said it would hold off on enforcement to give states time to build compliant systems at their own pace.
The grievance process itself would cover situations where beneficiaries face real-world access failures — a provider restricting visitor access, a facility limiting a resident’s ability to participate in community activities, or a state simply not delivering the services a person’s care plan calls for. For the disability community, it’s a mechanism with teeth. Without it, complaints have fewer formal channels.
What Remains in Place
The rest of the Access Rule isn’t on hold. States are still required to conduct annual reassessments of beneficiary service plans, maintain electronic incident management systems, meet response time standards for incidents, and hit minimum payment thresholds for direct care workers. The grievance system is the one piece being delayed — not the whole rule.
Alison Barkoff, a health law and policy professor at George Washington University who ran the HHS Administration on Community Living under the Biden administration, called the delay disappointing but urged states not to wait on CMS. “I hope that states will use the extra time to develop a best practice grievance system,” she said, adding that disability advocates are encouraging states to move as quickly as possible even without the enforcement pressure.
The Nursing Home Connection
For long-term care operators, HCBS policy matters more than it might appear. Home and community-based services function as an alternative to nursing home placement — when those services are functioning well, residents with disabilities and complex care needs can often avoid institutionalization. When they break down, nursing homes absorb the overflow. This delay leaves some of that safety net’s accountability mechanisms unfinished for another 18 months.
The dynamic isn’t new. As industry reports have documented, home care workforce pressures are already pushing some patients toward nursing homes, and any further erosion of home-based protections could widen that pipeline. The grievance delay means beneficiaries facing access failures have fewer formal options to resolve problems short of escalating to a facility setting.
CMS hasn’t indicated whether it plans any additional outreach or technical assistance to help states meet the 2027 date.
