MACPAC Urges Mandatory HCBS Wage Reporting

MACPAC elevated HCBS workforce wages as a rate-setting data gap and recommended mandatory wage reporting in its March 2026 Report to Congress on Medicaid and CHIP. MACPAC transmitted the report via letter dated March 12, 2026. The recommendation is framed as a workforce support strategy. MACPAC notes that workforce shortages constrain Medicaid’s ability to serve people with long-term care needs in home and community settings. In that context, the commission points to wage information as a key input for setting payment rates, while also emphasizing that the available wage data is limited.

March 2026 Report to Congress

In its March 12, 2026 transmittal letter, MACPAC foregrounds a recommendation intended to bolster the HCBS workforce. The recommendation would require states to report hourly wages paid to HCBS workers. MACPAC links wage reporting directly to more effective HCBS payment rate setting. In the report’s executive summary, MACPAC describes wage information as a critical but limited input to rate setting. The recommendation positions wage reporting as a way to address that limitation and improve the data available for rate development.

What MACPAC Recommends

MACPAC recommends that HHS direct CMS to amend a specific regulation to require wage reporting for workers delivering:

• Personal care

• Home health aide

• Homemaker

• Habilitation services

MACPAC also recommends that reporting be broken out by worker characteristics. The report specifies that this should include, at minimum:

• A licensed nurse vs. other direct care worker cut

• Rural vs. urban

In addition to requiring state reporting, MACPAC recommends that CMS publish the wage data.