The 2026 midterm elections flipped control of Congress from Republicans to Democrats, creating potential momentum for the home-based care industry and the risk of political gridlock.
Following Tuesday’s elections, home-based care advocates told Home Health Care News that the shift in political control could change the legislation that Congress pursues. They also said that Democrats’ previous actions, including an October request for information (RFI) on home care and long-term care benefits, paint a picture of what the home-based care industry can expect from the new Congress.
With President Donald Trump wielding the power of veto, legislation will require compromise, according to Jason Lee, CEO of the Home Care Association of America (HCAOA).
There is potential for the change in Congressional mix to provide added support for the home-based care industry, Lee said, but home-based care has historically been a bipartisan focus.
Lee noted that both Trump and Kamala Harris offered proposals to support home care during the 2024 presidential campaign.
“I think this creates just a whole new, different set of opportunities, especially with the RFI,” he said.
Democrats are likely to increase their focus on home care affordability, Medicaid and home- and community-based services in general, according to Eric Reinarman, vice president of government relations at HCAOA.
“In the RFI, for example, there’s discussion of a Medicare home care benefit,” Reinarman said. “That would be expensive. That’s a long road. I’m not suggesting that that’s going to be enacted anytime soon. But even the fact that that’s being discussed by the party that is now controls both chambers says a lot.”
HCAOA is a national trade association representing home care provider agencies offering personal care and non-medical support services.
A new congressional majority could also be more willing to press the Centers for Medicare & Medicaid Services (CMS) to protect access if payment cuts return, or consider a legislative fix, according to Denis Fleming Jr., chief government affairs officer of the National Alliance for Care at Home (the Alliance). However, CMS still sets Medicare home health and hospice payment rates through annual rulemaking.
The Alliance is a national advocacy organization representing providers across home health, hospice, palliative and home care.
New leadership may also be more receptive to concerns about access and workforce, so providers must continue to tell their stories, Fleming said.
“I would tell providers to expect a different tone, but not a change in priorities,” Fleming told HHCN in an email.
On the Medicaid side, given that rates are set at the state level, providers should keep in mind that state capitals matter as much as Washington, Fleming said.
A blueprint for Democrats’ focus
With Democrats taking control of both chambers, their RFI on home-based care becomes even more prominent and important, Lee told HHCN.
“We saw from the Senate Finance Committee Democrats a request for information, RFI, that dealt with home care and long-term care, and covered a number of key issues, including … the Medicaid access rule, the 80/20 provision,” Lee said.
Experts from the National Alliance for Care at Home (the Alliance) and LeadingAge also pointed to the RFI as a blueprint for Democrats’ likely agenda. The RFI marks access to universal, affordable home-based care as a core priority, Mollie Gurian, the vice president of government affairs at LeadingAge, told HHCN in an email.
LeadingAge is an association of nonprofit and mission-driven providers of aging services, including home-based care.
The Alliance was encouraged by the RFI’s direction, which includes options for a universal home care benefit based on functional need rather than age or income, according to Fleming.
Gurian also pointed to Democratic proposals to reverse Medicaid cuts that threaten HCBS, positioning the party’s agenda around both expanding benefits and protecting existing services.
Program integrity oversight likely to stay a priority
Home-based care providers and advocates have largely aligned around CMS’ focus on rooting out bad actors, though many have cautioned the agency against using broad tools to do so that could implicate compliant providers.
“We want oversight of home-based care in both Medicare and Medicaid to be targeted and effective, protecting beneficiaries while allowing high-quality providers to thrive without unnecessary administrative burdens,” Gurian said.
Fleming predicted that program integrity is likely to stay a top priority under new congressional leadership, particularly for CMS.
Democrats in Congress are unlikely to fully align with the Trump administration on its approach to fraud enforcement, Lee said, and are likely to put more focus on the Senate Finance Committee RFI.
The path ahead
While the midterms create opportunities for new support as well as the risk of a political stalemate, workforce shortages could constrain efforts to expand access regardless of congressional control.
HCAOA is advocating for EB-3 visa reform and a new visa specifically for home care workers, proposals that have drawn interest from both parties, Reinarman said. Still, expanding benefits will require sufficient staffing and a workable funding and implementation plan.
“That’s the big challenge is trying to truly address the workforce crisis because that’s our rate-limiting factor,” Reinarman said.
Home-based care industry advocates affirmed that the midterm results do not change their advocacy goals, and they will continue to work with Congress to improve access to high-quality in-home care.
“Looking ahead, we see an opportunity to build on this momentum while continuing to work with Congress and the administration on reimbursement and oversight,” Gurian said.
Companies featured in this article:
Home Care Association of America, LeadingAge, The National Alliance for Care at Home
