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The 2026 midterms shifted control of Congress from Republicans to Democrats, opening the possibility of greater federal attention to home-based care, Medicaid and long-term care. Industry advocates point to a Senate Finance Committee request for information as a signal of possible priorities, but legislation would face a Republican president’s veto power, and workforce and funding constraints remain.
The 2026 midterm elections shifted control of Congress from Republicans to Democrats, a change home-based care advocates say could bring new attention to affordability, Medicaid and long-term care while also increasing the risk of legislative gridlock. Any major bill would still face President Donald Trump’s veto power, and advocates say the election alone does not guarantee changes to care access or provider payments.
Advocates told Home Health Care News that Democrats’ earlier work, including an October request for information (RFI) on home care and long-term care benefits, offers clues about the new majority’s interests. The RFI raised topics including Medicaid access, home- and community-based services (HCBS), and a possible Medicare home care benefit. It is a request for input, not legislation or a commitment to enact a benefit.
Jason Lee, CEO of the Home Care Association of America (HCAOA), said the new congressional makeup could create opportunities, while stressing that home-based care has drawn support from both parties. HCAOA represents agencies providing personal care and other non-medical support. Eric Reinarman, the association’s vice president of government relations, said the Medicare benefit idea would be expensive and would take a long time to pursue. He said its discussion nevertheless signals the subject has a place on the agenda.
Denis Fleming Jr., chief government affairs officer of the National Alliance for Care at Home, said lawmakers might be more willing to press the Centers for Medicare & Medicaid Services (CMS) on access or consider a legislative response if payment cuts return. But CMS sets Medicare home health and hospice rates through annual rulemaking; the election does not itself change those rates. Fleming also emphasized that Medicaid payment decisions are made at the state level, so provider advocacy in state capitals remains important.
Congressional Control Meets Care Access
The change matters because Congress can shape the laws and oversight affecting Medicaid-funded HCBS, care affordability and federal program priorities. A Democratic majority may give those topics more hearings and legislative attention. The RFI has drawn interest from advocates as an indication of issues lawmakers may examine, including options for a home care benefit based on functional need rather than age or income.
That possibility should not be mistaken for a near-term expansion of coverage. Any new federal benefit would require agreement on design, cost and implementation, and could face opposition from the White House. Fleming told the publication providers should expect a different tone, but not necessarily different underlying priorities. For providers and families, the practical effects will depend on specific laws, agency rules and state Medicaid decisions—not just which party controls Congress.
The outcome also affects how policymakers balance access and program-integrity enforcement. Advocates generally support action against fraud, but warn that broad oversight tools can burden compliant providers. Mollie Gurian of LeadingAge said oversight should be targeted and effective while protecting beneficiaries and avoiding unnecessary administrative burdens.
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The RFI and Existing Policy Levers
The Senate Finance Committee Democrats’ RFI asked for information on home care and long-term care issues, including the Medicaid access rule and its 80/20 provision. Industry groups described the document as a potential guide to Democratic priorities. The Alliance said it was encouraged by discussion of a universal home care benefit tied to functional need, while LeadingAge highlighted affordability and protection of existing HCBS.
Federal and state responsibilities differ. CMS administers Medicare and sets home health and hospice payment rates through annual rulemaking, while states set Medicaid rates. That split means congressional attention could affect federal policy without resolving local reimbursement or access problems. Advocates also say the campaign proposals made by both Donald Trump and Kamala Harris in 2024 showed that home care has previously attracted bipartisan interest.
“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 Ideas Still Face Hurdles
It remains unclear which items in the RFI, if any, will become bills, how they would be funded, or whether a Medicare home care benefit could win enough support to advance. The source report identifies no enacted change to benefits or payment rates resulting from the midterms. With the president able to veto legislation, proposals may require compromise to become law.
The election’s effect on CMS enforcement is also unsettled. Fleming expects program integrity to remain a priority, while Lee said congressional Democrats may not fully align with the administration’s approach to fraud enforcement. How oversight will be targeted—and whether compliant providers face additional requirements—has not been determined. Workforce shortages could further limit access regardless of any policy expansion.
Advocates Turn to Congress and States
Home-based care organizations say they will continue pressing lawmakers and the administration on access, reimbursement and workforce needs. The RFI’s subjects may guide further discussions, but the next concrete indicators will be whether lawmakers introduce related legislation, hold hearings or pursue oversight changes. CMS’s annual Medicare payment rulemaking remains a separate route for changes to home health and hospice rates.
Providers will also keep advocating at the state level because Medicaid rates and access depend on state decisions. HCAOA has promoted EB-3 visa reform and a visa category specifically for home care workers, proposals Reinarman said have drawn interest from both parties. Whether those ideas advance, and whether any new policy can be matched with enough staff and workable funding, remains open.
Key Questions
What changed in Congress after the 2026 midterms?
Control shifted from Republicans to Democrats, giving Democrats control of both chambers, according to the source report.
Will the election create a Medicare home care benefit?
Not by itself. A Medicare home care benefit was discussed in a Senate Finance Committee Democrats’ RFI, but it is not an enacted policy. Advocates say such a proposal would be costly and would take time.
Could Medicare home health payment rates change?
CMS continues to set Medicare home health and hospice rates through annual rulemaking. Advocates say the new Congress could increase pressure on CMS or consider legislation, but no rate change is confirmed as a result of the election.
Why do state elections and decisions matter to home-based care?
Medicaid rates are set at the state level, according to Fleming. Federal policy may shape the broader framework, but state decisions affect funding and access for Medicaid-funded home- and community-based services.
What could limit expansion of home-based care?
Advocates identify workforce shortages, funding and implementation as constraints. Additional benefits would need enough staff and a workable payment plan to translate into expanded access.
Source: homehealthcarenews.com
