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The 2026 midterms shifted control of both chambers of Congress to Democrats, potentially putting home-based care affordability, Medicaid and home- and community-based services higher on the agenda. Industry advocates say major changes will still require compromise with President Donald Trump, while workforce shortages and state-level Medicaid decisions remain significant constraints.
The 2026 midterm elections shifted control of Congress from Republicans to Democrats, creating a possible opening for legislation on home-care affordability, Medicaid and home- and community-based services. But advocates say the change does not guarantee new benefits: President Donald Trump can veto legislation, and providers continue to face staffing and funding constraints.
Home-based care advocates told Home Health Care News that the change in congressional control could affect which proposals lawmakers pursue. They pointed to an October request for information (RFI) from Senate Finance Committee Democrats on home care and long-term care as an indication of issues likely to receive attention. The RFI raised subjects including the Medicaid access rule, its 80/20 provision and possible approaches to a Medicare home-care benefit.
Jason Lee, CEO of the Home Care Association of America (HCAOA), said the new congressional lineup could create opportunities, while stressing that home care has drawn support from both parties. HCAOA represents agencies providing personal care and non-medical support services. Eric Reinarman, the association’s vice president of government relations, said Democrats are likely to give more attention to affordability, Medicaid and home- and community-based services.
Reinarman cautioned that a Medicare home-care benefit discussed in the RFI would be expensive and would take time to develop. Denis Fleming Jr., chief government affairs officer at the National Alliance for Care at Home, said a new majority could be more willing to press the Centers for Medicare & Medicaid Services (CMS) on access and possible responses to payment cuts. CMS continues to set Medicare home health and hospice rates through annual rulemaking.
Congress Could Revisit Home-Care Access
The election matters to providers and people who rely on care at home because Congress can shape federal benefit policy, funding and oversight. Advocates see the Democratic RFI as a sign that lawmakers may consider ways to expand access and protect existing services, including Medicaid-funded home- and community-based services. Those are potential policy directions, not enacted changes.
Any federal proposal would have to move through a Congress now controlled by Democrats while the White House is held by Trump. HCAOA CEO Jason Lee told Home Health Care News that legislation will require compromise given the president’s veto power. The outcome could be new negotiations, limited legislation or stalemate; the election alone does not settle which path lawmakers will take.
For Medicaid-funded care, the policy picture is also shaped by decisions made in state capitals, where rates are set. Fleming said providers should treat state advocacy as important alongside work in Washington. And even if lawmakers authorize broader coverage, available workers and a workable funding plan will affect whether services can be delivered.
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The October RFI Offers Policy Clues
The Senate Finance Committee Democrats’ RFI sought input on home care and long-term care. Advocates described it as a guide to the issues Democrats may pursue, rather than a bill or a commitment to enact a particular benefit. LeadingAge, an association of nonprofit and mission-driven aging-services providers, said the RFI framed universal, affordable home-based care as a priority. The Alliance said it was encouraged by options for a benefit based on functional need rather than age or income.
Advocates also pointed to Democratic proposals to reverse Medicaid cuts they say could threaten home- and community-based services. At the same time, groups across the sector have generally supported efforts to address fraud and improper billing, while warning that broad enforcement measures could burden compliant providers. Mollie Gurian of LeadingAge said oversight should protect beneficiaries while allowing high-quality providers to operate without unnecessary administrative burdens.
The election changes the congressional setting for those discussions, but it does not replace existing administrative processes. CMS still establishes Medicare home health and hospice payment rates through annual rulemaking, and Medicaid rates are determined at the state level. The Alliance has said a new congressional majority might press CMS on access if payment cuts return or consider a legislative response.
“I think this creates just a whole new, different set of opportunities, especially with the RFI.”
— Jason Lee, CEO of the Home Care Association of America
Policy Proposals Face Major Hurdles
The election results do not establish whether Congress will advance a Medicare home-care benefit, change Medicaid policy or adopt a fix for any future payment reductions. The RFI is a request for information, and advocates’ descriptions of Democrats’ likely agenda are assessments, not a confirmed legislative schedule. The source report does not identify a specific bill, timetable or agreement with the White House.
It is also unclear how lawmakers will approach program-integrity enforcement. Advocates support targeted action against fraud but have raised concerns that broad tools could impose administrative costs on compliant providers. The eventual balance between enforcement and provider access will depend on decisions by Congress and CMS.
Workforce proposals are another open question. HCAOA is advocating for changes to the EB-3 visa program and a visa specifically for home-care workers, which Reinarman said have drawn interest from both parties. The source report does not confirm that either proposal has sufficient support to become law, or how quickly any workforce increase could be achieved.
Advocates Press Congress and States
Home-care organizations say they will continue working with Congress and the administration on access, reimbursement, workforce and oversight. Providers are also being urged to explain how policy decisions affect people receiving care and the agencies that serve them. Further developments will depend on whether lawmakers turn RFI responses and policy priorities into legislation, and whether any proposal can secure support across the branches of government.
Providers will need to follow state-level Medicaid decisions as well as federal debates, since states set Medicaid rates. Separately, annual CMS rulemaking remains the process for Medicare home health and hospice payment rates. The available source material does not give dates for a new bill or a specific upcoming vote, so the timing and scope of policy changes remain unsettled.
Key Questions
What changed for home-based care after the 2026 midterms?
Control of Congress shifted from Republicans to Democrats. Advocates say that could give more attention to home-care affordability, Medicaid and home- and community-based services, but it does not itself change benefits or payments.
Will a Medicare home-care benefit be created?
That is not confirmed. A possible Medicare home-care benefit appeared in the Senate Finance Committee Democrats’ RFI, but HCAOA’s Eric Reinarman said such a benefit would be expensive and would take a long time to develop.
Could Congress change Medicaid home-care services?
Lawmakers could consider Medicaid policy, including proposals to protect home- and community-based services. No change is confirmed, and Medicaid rates are set at the state level, so state decisions also matter.
Why might expanded coverage not quickly increase access?
Providers say workforce shortages are a major constraint. More funding or broader benefits would still require enough workers and a workable plan for paying for and implementing services.
Source: homehealthcarenews.com
