Inequities in access to Medicaid HCBS services are widespread, and limited funds have resulted in many unmet needs for HCBS. As HCBS cost issues have been a primary focus of policy makers, access and quality problems have not been sufficiently addressed. As 2009 marks the beginning of a new presidency and Congress, it is important to examine the progress that has been made in providing Medicaid HCBS along with many current problems. The focus of this article is to examine issues of access, cost, and quality for Medicaid HCBS programs and to suggest policy changes (abstract from p. 13 of article).