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The 2026 midterm elections shifted control of Congress to Democrats, giving home-based care advocates a potential opening to pursue priorities such as affordability, Medicaid access and home- and community-based services. The change does not guarantee new benefits or prevent payment disputes: President Donald Trump retains veto power, CMS controls annual Medicare payment rulemaking, and states set Medicaid rates.
Democrats won control of both chambers of Congress in the 2026 midterms, opening a new potential path for legislation affecting home-based care while raising the prospect of conflict with President Donald Trump. Industry advocates say the change could put more attention on care affordability, Medicaid and home- and community-based services, but they caution that major policy changes would require compromise, funding and enough workers to deliver care.
Advocates interviewed by Home Health Care News pointed to an October request for information (RFI) from Senate Finance Committee Democrats on home care and long-term care as an indicator of issues the new congressional majority may examine. The RFI raised topics including Medicaid access, the Medicaid 80/20 provision and a possible Medicare home-care benefit. It is a request for input, not legislation or a promise that a benefit will be enacted.
Jason Lee, CEO of the Home Care Association of America (HCAOA), said the new congressional balance creates different opportunities for the industry, particularly in light of the RFI. HCAOA represents agencies providing personal care and non-medical support. The association’s vice president of government relations, Eric Reinarman, said Democrats may put greater emphasis on affordability, Medicaid and home- and community-based services. He also stressed that a Medicare home-care benefit would be expensive and would face a lengthy legislative path.
Denis Fleming Jr., chief government affairs officer at the National Alliance for Care at Home, said a Democratic majority could be more receptive to concerns about access and the workforce, and could press the Centers for Medicare & Medicaid Services (CMS) to protect access if payment cuts return. CMS continues to set Medicare home health and hospice rates through annual rulemaking. Medicaid rates, by contrast, are set at the state level, meaning federal election results are only part of the policy picture.
How Congress Could Shape Care Access
The shift matters to providers and families because federal policy can influence which services are funded, who can access them and how providers are paid. A congressional focus on Medicaid and home- and community-based services could bring attention to coverage gaps and the effects of proposed or existing cuts. Discussion of a Medicare home-care benefit could also broaden the debate over how people with care needs receive support at home.
Those possibilities are not the same as enacted policy. Trump’s veto authority means legislation would need enough support to overcome that obstacle or be shaped through compromise. And congressional attention does not replace CMS’s administrative role in setting Medicare rates. For providers, the practical effect of the election will depend on what lawmakers advance, what the administration does, and whether measures can be funded and implemented.
The workforce is another direct limit on access. Reinarman described staffing as the industry’s rate-limiting factor: expanding coverage without enough workers may not translate into more available care. HCAOA is advocating for EB-3 visa reform and a visa specifically for home-care workers, proposals Reinarman said have drawn interest from both parties. The source report does not establish that either proposal will advance.
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The RFI and Existing Policy Divisions
The Senate Finance Committee Democrats’ RFI asked for views on home care and long-term care. Industry groups see it as a possible guide to the new majority’s interests, including access, affordability and the future of Medicaid services. Mollie Gurian, vice president of government affairs at LeadingAge, said the request placed universal, affordable home-based care among Democrats’ priorities. LeadingAge represents nonprofit and mission-driven aging-services providers, including home-based care organizations.
Advocates also cited Democratic proposals to reverse Medicaid cuts they say could threaten home- and community-based services. The Alliance said it was encouraged by the RFI’s consideration of a universal home-care benefit based on functional need rather than age or income. These are descriptions of proposals and policy discussions, not evidence that Congress has approved them.
Oversight is likely to remain part of the debate regardless of party control. Providers and advocates have broadly supported efforts to address fraud, while warning that broad enforcement tools could burden compliant agencies or affect access. Gurian said oversight should target wrongdoing while allowing high-quality providers to operate without unnecessary administrative requirements.
“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 Face Hurdles
It is not yet clear which proposals the new Congress will turn into legislation, how any measures would be financed, or whether they could win support from the president. The RFI indicates that lawmakers are seeking information; it does not establish a legislative timetable or outcome. The source report also does not specify the final composition of committees or the details of any bill that may follow.
The scale and timing of any Medicare payment changes remain unsettled. CMS sets Medicare home health and hospice rates through annual rulemaking, while potential congressional action could depend on whether payment cuts return and whether lawmakers pursue a legislative response. At the state level, Medicaid rates and implementation decisions can vary, so a federal change would not necessarily produce the same effects everywhere.
It is also uncertain whether the new majority’s approach to program-integrity enforcement will differ in practice, or how any new benefits could be staffed. Advocates say oversight must protect beneficiaries without imposing unnecessary burdens on compliant providers, but the balance and specific enforcement tools remain to be determined.
Advocates Turn to Congress and States
Home-care groups say they will continue working with Congress and the administration on access, reimbursement, workforce and oversight. The next meaningful signals will be whether lawmakers act on issues raised in the Senate Finance Committee RFI, introduce specific legislation, or address Medicaid and home-care services through budget or oversight work. No enactment or timetable for a new federal benefit was established in the source report.
Providers will also need to track CMS’s annual Medicare payment rulemaking and decisions by state governments on Medicaid rates and services. Fleming advised providers to keep communicating concerns about access and workforce needs, while recognizing that state capitals matter alongside Washington for Medicaid policy.
Advocacy on staffing is expected to continue, including HCAOA’s efforts around visa proposals. Whether those proposals gain legislative traction—and whether any expansion of benefits is matched by funding and available workers—will help determine how much the election changes care on the ground.
Key Questions
What changed in Congress after the 2026 midterms?
Democrats took control of both chambers of Congress, according to the source report. That could affect which home-care issues lawmakers prioritize, but it does not by itself enact new policy.
Does the election mean Medicare will cover a new home-care benefit?
No. A possible Medicare home-care benefit was discussed in a Senate Finance Committee Democrats’ request for information. Reinarman said such a benefit would be expensive and face a long path; no approval or timetable was reported.
Why do states still matter for home-based care?
Medicaid rates are set at the state level, according to the Alliance’s Denis Fleming Jr. State policy and implementation can therefore affect providers and access even as Congress debates federal policy.
What could limit efforts to expand home care?
Advocates identified workforce shortages and funding as constraints. Expanding benefits may not increase available care unless providers can recruit and retain enough workers and the programs have a workable financing and implementation plan.
Source: homehealthcarenews.com
