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The 2026 midterms shifted control of Congress from Republicans to Democrats, giving home-based care advocates a potential opening to advance affordability, Medicaid and home- and community-based services. Industry leaders also warn that a presidential veto, state-level Medicaid decisions and a shortage of workers could constrain change; no specific new benefit or policy has been enacted.
Democrats’ 2026 midterm gains gave the party control of both chambers of Congress, creating a possible opening for legislation on home-based care affordability, Medicaid and home- and community-based services. Advocates quoted by Home Health Care News said the shift could also bring gridlock: President Donald Trump can veto legislation, and the outcome of any policy effort remains uncertain.
Home Health Care News reported that advocates see Democrats’ October request for information (RFI) on home care and long-term care benefits as a guide to issues the new Congress may take up. The RFI discussed several topics, including a possible Medicare home care benefit, Medicaid access and the 80/20 provision. The document signals areas of interest; it does not mean Congress has approved or will enact those proposals.
Jason Lee, CEO of the Home Care Association of America (HCAOA), said the change in congressional control could create new opportunities, particularly in light of the RFI. HCAOA represents agencies providing personal care and non-medical support. The report also quoted HCAOA vice president of government relations Eric Reinarman, who said Democrats are likely to focus more on affordability and Medicaid. He cautioned that a Medicare home care benefit would be expensive and would take time to develop.
Denis Fleming Jr., chief government affairs officer of 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 beneficiary access and possible legislative responses if payment cuts return. CMS continues to set Medicare home health and hospice rates through annual rulemaking. Fleming also stressed that Medicaid rates are set by states, making state capitals important alongside Washington.
Congressional Control Meets Care Access
The change in congressional control may affect which home-care priorities receive hearings, oversight and legislative attention. If lawmakers pursue the themes in the RFI, debates could include whether to expand coverage, how to protect Medicaid-funded home- and community-based services, and how to address payment and access concerns. Those are potential policy discussions, not enacted changes.
For providers and people who rely on care at home, the distinction matters: changes to benefits, payment rates or eligibility could affect service availability and provider finances, but the election itself changes none of those rules. A presidential veto could complicate legislation, while Medicaid decisions remain partly dependent on state policy. Industry advocacy is likely to continue at both levels.
Workforce capacity is another constraint. Reinarman told Home Health Care News that staffing is a limiting factor for expanding access, even if lawmakers support new benefits. More coverage would not automatically produce more available care without workers and a workable funding and implementation plan.
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The RFI Sets Out Policy Questions
The Senate Finance Committee Democrats’ October RFI sought input on home care and long-term care. According to the report, its subjects included the Medicaid access rule, the 80/20 provision and options for a Medicare home care benefit. The Alliance said the RFI included discussion of a universal home care benefit based on functional need rather than age or income. These are proposals or options under discussion, not current entitlements.
LeadingAge, an association representing nonprofit and mission-driven aging-services providers, also pointed to the RFI as a sign of likely Democratic priorities. Its vice president of government affairs, Mollie Gurian, said the document framed affordable home care as a priority and highlighted protecting existing services. Advocates have also supported efforts to address fraud, while warning that broad enforcement measures could burden providers that comply with the rules.
The political shift does not remove the executive branch’s role. CMS makes Medicare home health and hospice payment decisions through annual rulemaking, while Congress may influence oversight or consider legislation. And because Medicaid rates are set at the state level, federal election results do not determine every policy affecting home-based 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 Proposals Still Need a Path
No legislation described in the report has created a new Medicare home care benefit, reversed Medicaid cuts or changed payment rules. It remains unclear which RFI topics congressional leaders will pursue, whether proposals will attract support across party lines, and whether any bill could secure the president’s approval. A possible veto makes compromise relevant, but its effect on specific proposals is not yet known.
The report does not specify what action CMS may take on future payment rates or how states will respond to Medicaid access and funding debates. The scale and timing of any workforce reforms, including visa proposals discussed by HCAOA, also remain unsettled. Advocates’ forecasts about the new Congress are expectations, not confirmed outcomes.
Advocates Turn to Congress and States
Home-based care groups say they will continue pressing Congress and the administration on access, reimbursement, workforce and program integrity. Lawmakers’ next steps on the RFI’s subjects will show whether the document becomes a basis for hearings or legislation; the report does not identify a specific deadline or scheduled vote.
Providers will also watch CMS’s annual Medicare payment rulemaking and state-level Medicaid decisions, which can affect services independently of federal legislation. HCAOA has advocated for changes to the EB-3 visa process and a visa specifically for home care workers, according to Reinarman. Whether those proposals advance, and whether any staffing gains can meet future demand, remains to be seen.
Key Questions
What changed for home-based care after the 2026 midterms?
Democrats gained control of both chambers of Congress, potentially changing which home-care issues receive attention. No home-care benefit or payment rule changed solely because of the election.
Does the October RFI create a Medicare home care benefit?
No. The RFI raised policy questions and options, including discussion of a possible benefit. It is not legislation and does not establish coverage.
Why could policy changes be difficult?
President Donald Trump can veto legislation, and advocates say proposals would need compromise. Workforce shortages and funding and implementation questions could also limit expansion, while Medicaid rates are set at the state level.
What should providers watch next?
Providers can follow congressional action on the RFI’s topics, CMS’s annual Medicare payment rulemaking and state Medicaid decisions. The timing and outcome of those developments are not yet clear.
Source: homehealthcarenews.com
