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The 2026 midterms shifted control of Congress from Republicans to Democrats, giving home-based care advocates new openings to press for affordability, Medicaid and access proposals. Any major legislation would still face negotiations with President Donald Trump, while payment policy, workforce shortages and state-level Medicaid decisions remain significant constraints.
The 2026 midterm elections shifted control of Congress from Republicans to Democrats, creating new openings for debate over home-based care affordability, Medicaid and long-term services while leaving major policy changes uncertain. Advocates interviewed by Home Health Care News said the new congressional majority may give greater attention to home care, but legislation would need to account for President Donald Trump’s veto power and the sector’s persistent workforce shortages.
Advocates pointed to an October request for information (RFI) from Senate Finance Committee Democrats as an early indication of issues the party may pursue. The inquiry addressed home care and long-term care benefits, including Medicaid access and the Medicaid rule that requires certain providers to spend at least 80% of Medicaid payments on compensation for direct-care workers. The RFI also discussed a possible Medicare home care benefit.
Jason Lee, CEO of the Home Care Association of America (HCAOA), said the election creates a different set of opportunities, particularly in light of the RFI. Eric Reinarman, the association’s vice president of government relations, cautioned that a Medicare home care benefit would be expensive and would take time to develop. He said its appearance in the discussion does not mean it will be enacted soon.
Denis Fleming Jr., chief government affairs officer of the National Alliance for Care at Home, said new congressional leadership could be more receptive to concerns about access and could press the Centers for Medicare & Medicaid Services (CMS) if payment cuts return. However, CMS continues to set Medicare home health and hospice rates through annual rulemaking. Medicaid rates are set at the state level, Fleming said, making state policy decisions important alongside federal action.
Federal Priorities Meet Local Care Needs
The change in Congress could affect which home-care proposals receive hearings, oversight and legislative attention. Advocates see potential for more emphasis on affordable care, Medicaid home- and community-based services (HCBS), and access. These issues matter to providers and the people who rely on in-home support because funding and program rules affect what services are available and who can receive them.
But control of Congress alone does not determine policy. With a Republican president able to veto legislation, lawmakers may need bipartisan agreement to enact major changes. And federal debates are only part of the picture: states set Medicaid rates and administer many HCBS programs. The election may change the tone in Washington without quickly changing the services or payments providers receive.
Providers also face an operational limit that legislation cannot remove by itself: staffing capacity. Reinarman said the workforce crisis is a rate-limiting factor for expanding access. Proposals to broaden benefits would need funding and an implementation plan that can account for the availability of workers.
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The RFI Sets Out Democratic Interests
The Senate Finance Committee Democrats’ RFI outlined questions and options relating to home care and long-term care. Advocates described it as a guide to the party’s likely priorities, not as an enacted policy or a promise that any particular proposal will advance. Lee highlighted its coverage of Medicaid access and the 80/20 provision. LeadingAge vice president of government affairs Mollie Gurian said the inquiry framed universal, affordable home-based care as a priority.
Fleming said the Alliance was encouraged by discussion of a possible universal home care benefit based on functional need rather than age or income. Gurian also pointed to Democratic proposals to reverse Medicaid cuts that advocates say threaten HCBS. These ideas would expand or protect services, but their costs, legislative prospects and eventual design remain unsettled.
The election does not replace existing agency processes. Medicare home health and hospice payment rates remain subject to CMS annual rulemaking, while Medicaid payment decisions are made at the state level. Home care also spans different services and programs: HCAOA represents agencies providing personal care and non-medical support, while the Alliance represents providers across home health, hospice, palliative and home care.
“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 Details Still Undecided
The election result does not establish which proposals will advance, whether Congress will pass any home-care legislation, or how the White House would respond. The RFI is an inquiry and policy signal, not a finalized benefit. In particular, the scope, cost and eligibility rules for a possible Medicare home care benefit have not been settled in the material available.
It is also unclear whether Congress will take action on Medicaid cuts or the 80/20 provision, and whether CMS will face new legislative direction on Medicare payment policy. Annual rate-setting remains with CMS, while state governments retain authority over Medicaid rates. The election’s practical effects will therefore vary by program and jurisdiction.
Advocates broadly support efforts to address fraud, but they differ from the Trump administration on how enforcement should be carried out. Gurian called for oversight to be targeted and effective. The specific enforcement approach under the new Congress, and how it might affect providers, has not been established. Workforce proposals such as EB-3 visa reform or a new visa for home-care workers also remain advocacy priorities, not enacted changes.
Advocates Prepare for Federal Talks
Home-care groups say they will continue engaging with Congress and the administration on reimbursement, access, workforce and program integrity. The Senate Finance Committee RFI may help shape the next stage of Democratic policy discussions, but the proposals it raises would still need development and, for legislation, support from both Congress and the president.
Providers will also need to follow CMS annual payment rulemaking and decisions in state capitals on Medicaid rates and HCBS. Those processes can affect operations even if Congress does not pass a new national benefit. Advocates are urging providers to explain how policy choices affect service access and workforce capacity as lawmakers set their agendas.
The next meaningful signs will be whether congressional leaders turn the RFI’s topics into hearings, bills or budget proposals, and whether bipartisan negotiations produce changes. Until those steps occur, the midterm result signals a potential shift in attention, not a confirmed change in coverage or payment.
Key Questions
What changed for home-based care after the 2026 midterms?
Control of Congress shifted from Republicans to Democrats. Advocates say that may give more attention to home-care affordability, Medicaid and access, but it does not itself change benefits or payment rates.
Will Congress create a Medicare home care benefit?
That is uncertain. A Senate Finance Committee Democrats’ RFI discussed the possibility, but advocates said such a benefit would be expensive and a long-term prospect, not an imminent outcome.
Can the new Congress change Medicare home health payments?
Congress could pursue legislation or oversight, but CMS currently sets Medicare home health and hospice payment rates through annual rulemaking. No specific change resulting from the election has been confirmed.
Why do state elections and decisions matter?
States set Medicaid rates and administer many home- and community-based services. Advocates say state policy can affect providers and access as much as federal debate does.
What could limit expansion of home-based care?
Workforce shortages are a major constraint identified by industry advocates. Expanding benefits would require enough workers, along with workable funding and implementation plans.
Source: homehealthcarenews.com
