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The 2026 midterms gave Democrats control of both chambers of Congress, potentially increasing attention to home-care affordability, Medicaid and home- and community-based services. Industry advocates say the shift creates opportunities, but President Donald Trump’s veto power, funding and staffing constraints, and state control of Medicaid rates limit what may change.
The 2026 midterms shifted control of Congress from Republicans to Democrats, creating potential openings for home-based care legislation while raising the prospect of gridlock. Advocates say the new majority may focus more on home-care affordability, Medicaid and home- and community-based services, but major policy changes would require negotiations with President Donald Trump and face funding and workforce constraints.
Industry leaders told Home Health Care News that the change in congressional control could alter which proposals receive attention. The Senate Finance Committee Democrats’ October request for information on home care and long-term care is seen by advocates as a signal of possible priorities. The RFI addressed topics including the Medicaid access rule, its 80/20 provision and a possible Medicare home-care benefit.
Jason Lee, CEO of the Home Care Association of America, 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 a long time to pursue. Its appearance in the RFI indicates discussion, not an approved or imminent program.
Denis Fleming Jr., chief government affairs officer of the National Alliance for Care at Home, said a new congressional majority could be more willing to press the Centers for Medicare & Medicaid Services to protect access if payment cuts return, or consider a legislative response. However, CMS continues to set Medicare home health and hospice payment rates through annual rulemaking. Medicaid rates are set at the state level, so federal election results do not determine those rates directly.
Federal Priorities Meet Local Constraints
Congressional control matters because it can affect which bills receive hearings, committee attention and votes. A greater focus on affordable home care and Medicaid-funded services could shape debate over access and benefit design. For providers, the immediate impact may be more on advocacy and oversight than on reimbursement or coverage: no new benefit or payment change is established by the election alone.
The policy questions have direct consequences for people who rely on care at home, their families and the organizations that provide it. But even if lawmakers support expanding services, implementation depends on a viable funding plan and enough workers to deliver care. Reinarman described workforce shortages as the industry’s rate-limiting factor. That means a broader benefit would not automatically translate into available care in every community.
Oversight is another practical concern. Advocates say efforts to address fraud should protect beneficiaries while avoiding broad rules that burden compliant providers. The new Congress may scrutinize the Trump administration’s enforcement approach, but Fleming expects program integrity to remain a priority, particularly for CMS. The details of enforcement, rather than the goal itself, may become a point of disagreement.
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The October RFI as a Signal
The October request for information came from Senate Finance Committee Democrats before the election. It asked about home care and long-term care issues and included discussion of a possible Medicare home-care benefit. With Democrats now controlling both chambers, advocates say the document has gained importance as an indication of areas the party may pursue. It remains an RFI: it gathers input and does not itself create policy.
LeadingAge, an association of nonprofit and mission-driven aging-services providers, characterized access to universal, affordable home-based care as a central concern reflected in the RFI. Fleming said the Alliance welcomed its consideration of a possible universal benefit based on functional need rather than age or income. Advocates also point to Democratic proposals to reverse Medicaid cuts they say could threaten home- and community-based services.
The election does not remove the need for bipartisan cooperation. Lee noted that both Trump and Kamala Harris proposed support for home care during the 2024 presidential campaign, and said the issue has historically drawn attention across party lines. But with Trump retaining the presidential veto, measures that pass Congress could still require compromise to become law.
“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 Plans Face Unresolved Hurdles
The election result does not determine whether Congress will enact a Medicare home-care benefit, reverse Medicaid reductions or change federal payment policies. The RFI is a request for input, not legislation, and the source report does not identify a bill, timetable or agreed funding plan for the proposals discussed.
It is also unclear how far Democrats and the Trump administration will agree on care access, payment or fraud enforcement. The president’s veto power could block legislation that does not gain broader support. Meanwhile, Medicaid payment levels and many implementation decisions remain shaped by states, and the severity of workforce shortages varies across providers and locations.
Advocates have also not specified what legislative or regulatory changes will follow the election. Their comments describe potential priorities and expectations, not decisions already made by Congress or CMS.
Advocates Prepare for the New Congress
Home-based care groups say they will continue pressing Congress and the administration on access, reimbursement, workforce and program oversight. Providers are expected to keep sharing evidence about local access and staffing needs with lawmakers, while advocates monitor how the new majority responds to the Senate Finance Committee’s RFI.
Possible developments include hearings, legislation or further administration action, but the source report does not give a confirmed schedule. CMS will continue its annual rulemaking for Medicare home health and hospice rates, while state governments remain important venues for Medicaid policy and payment decisions.
For now, the election changes the political setting, not the services or rates providers receive. The next meaningful indicators will be the committee’s follow-up to the RFI, any proposals introduced in Congress, and whether lawmakers can reach agreements on funding, access and workforce measures.
Key Questions
Who controls Congress after the 2026 midterms?
The elections shifted control of both chambers from Republicans to Democrats, according to the source report.
Does the election create a Medicare home-care benefit?
No. The October RFI discussed a possible benefit, but it is a request for information rather than enacted legislation. Advocates say a benefit would be expensive and would take a long time to pursue.
Could the election affect Medicaid home-care services?
It could change federal debate about Medicaid and home- and community-based services. However, Medicaid rates are set at the state level, and no specific post-election change is confirmed.
What could limit expansion of home-based care?
Advocates identify workforce shortages as a major constraint, alongside funding and implementation challenges. Expanding coverage would not by itself provide enough workers to deliver care.
What happens next for home-care policy?
Advocates plan to continue working with Congress and the administration. Lawmakers’ follow-up to the RFI, potential legislation and CMS’s annual Medicare rate-setting process are developments to watch; no specific timetable for congressional action has been announced.
Source: homehealthcarenews.com
