U.S. Senate Finance Committee Ranking Member Ron Wyden (D-Oregon) has issued an 81-page Request for Information (RFI) exploring a major overhaul of the nation's long-term care system, including the creation of a universal home care benefit that could significantly expand access to personal care and other home-based services.

Released October 16, the RFI, Delivering an Affordable Home Care Guarantee for American Families, builds on a May 2026 initiative by Senator Wyden and fellow Senate Democrats calling for expanded Medicare home care coverage and increased Medicaid funding for home- and community-based services (HCBS). The latest effort seeks detailed stakeholder feedback on how a universal benefit could be structured, financed, and administered, alongside proposals to strengthen the caregiving workforce.

Central to the initiative is the concept of guaranteeing access to home care based on an individual's functional needs rather than age, income, disability status, or work history. The RFI also explores improvements to nursing home quality, caregiver compensation, and oversight of long-term care providers.

While no comprehensive legislation has emerged from this effort, its political prospects could change following the November 3 midterm elections. If Democrats regain control of the U.S. House of Representatives, the Senate, or both, a shift in congressional leadership could create new opportunities to advance portions of the proposal during the 120th Congress, which convenes January 3, 2027. Significant legislative hurdles would remain, particularly if control of Congress is divided between the parties.

What's Under Consideration?

The RFI seeks input on several approaches to expanding home care coverage and strengthening the long-term care system, including:

• Universal Home Care Coverage: Establishing a new Medicare home care benefit, potentially covering up to 20 hours of weekly assistance with activities of daily living, or making Medicaid HCBS a mandatory benefit without enrollment caps or waiting lists.
• Eligibility and Affordability: Determining eligibility based on functional and cognitive needs rather than age, income, or diagnosis, while exploring beneficiary cost-sharing arrangements based on income and assets.
• Provider Reimbursement: Establishing adequate payment rates, geographic adjustments, and reimbursement benchmarks to support provider viability, competitive wages, and expanded access to services.
• Workforce Development: Strengthening caregiver compensation, training, benefits, career pathways, and support for paid and unpaid family caregivers.
• Medicaid Payment Requirements: Examining the Medicaid Access Rule's requirement that 80% of certain home care payments be directed toward direct care worker compensation, including concerns about implementation, administrative costs, and financial sustainability.
• Nurse Registries and Employment Classification: Exploring the role of caregiver registries in workforce recruitment and service delivery, alongside potential changes to federal independent contractor classification rules and the Fair Labor Standards Act's (FLSA) companionship exemption.
• Managed Care and Oversight: Evaluating Medicare Advantage's potential role in administering a new home care benefit, Medicaid managed care arrangements, provider networks, payment structures, consumer protections, and program integrity safeguards.

The RFI also considers whether Medicare and Medicaid should share responsibility for providing home-based services, including a phased approach under which Medicare would cover a baseline level of care and Medicaid would finance additional services based on individual needs.

Although the initiative focuses on expanding access to long-term care, its implications extend beyond coverage. Potential changes to reimbursement methodologies, workforce classifications, regulatory requirements, and program administration could significantly affect how Florida's licensed home health agencies, nurse registries, and other home care providers operate.

HCAF Seeks Member Feedback by December 4

The National Alliance for Care at Home is reviewing the RFI and gathering input from state associations and industry stakeholders to inform its response to the Senate Finance Committee.

"This RFI is an encouraging step toward making care at home more accessible for American families," said Patrick Harrison, Vice President of Policy & Legislative Affairs for the National Alliance for Care at Home, in comments to McKnight's Home Care. The Alliance plans to submit comments and continue working with lawmakers to ensure any new benefit protects and expands access to care at home.

HCAF is requesting feedback from member providers by Friday, December 4, 2026, at 5:00 PM ET, to help ensure that Florida's home care industry is represented as policymakers consider these potentially far-reaching reforms.

Members are encouraged to review the proposals and share their perspectives on how the contemplated changes could affect their agencies, caregivers, patients, and clients. HCAF is particularly interested in feedback regarding:

• Reimbursement adequacy and the financial sustainability of expanded home care coverage
• Workforce recruitment, retention, compensation, and training requirements
• Independent contractor classifications and the operational differences between licensed home health agencies and nurse registries
• Medicaid managed care reimbursement, administrative requirements, and access to services
• Consumer protections, regulatory oversight, and safeguards that promote accountability without creating unnecessary barriers to care

Real-world examples are especially valuable. Members are encouraged to identify existing policies that create operational challenges, describe their effects on access to care, and recommend changes that would better support providers and the individuals they serve.

HCAF will evaluate member feedback and coordinate with the National Alliance for Care at Home as it prepares its response. Comments to the Senate Finance Committee are due December 18, 2026.

Member Feedback Deadline: Friday, December 4, 2026, at 5:00 PM ET

Members are encouraged to review the full RFI and submit their feedback by the December 4 deadline to HCAF Senior Director of Policy, Advocacy & Communications Kyle Simon at ksimon@homecarefla.org.

Your input will help ensure that Florida providers' experiences, operational realities, and priorities are considered as federal policymakers explore potentially significant changes to the future of care at home.