On May 3, 2023 the Centers for Medicare & Medicaid Services (CMS) published the proposed rule Medicaid Program; Ensuring Access to Medicaid Services. The proposed rule seeks to increase transparency in payment rates, standardize data and monitoring and create new opportunities for states to promote active beneficiary engagement in their Medicaid programs, with the goal of improving access to care. The rule also has a particular focus on home and community-based services (HCBS), including direct care worker compensation requirements, grievance process development, critical incident reporting definitions and HCBS quality reporting.