Midterm Elections and Home Care. What Changes When Congress Flips

Tuesday's results flipped both chambers of Congress. As of Wednesday morning, Democrats held at least 54 Senate seats and 228 House seats, with votes still being counted, according to the Home Care Association of America. For agency owners, the midterm elections and home care policy now sit closer together than they did a week ago. The new majority takes over in January and will work across from a Republican White House with veto power, so big bills still need deals across party lines.

Medicaid and HCBS move to the front

Democratic leaders have said their first health priority is rolling back the Medicaid cuts in the 2025 budget law. Vox reports insiders expect a health-focused reconciliation package, since a reconciliation bill needs only 50 Senate votes. Getting a president to sign away part of his own bill is a long shot. Even so, Medicaid pays for most personal care and waiver services, and a serious fight over those cuts will shape state budgets next year. Watch your own state as well. Governors set Medicaid rates, and Democrats will hold at least 28 governorships. Denis Fleming Jr. of the National Alliance for Care at Home told Home Health Care News that state capitals matter as much as Washington.

The Senate Finance RFI becomes a blueprint

In October, Senate Finance Committee Democrats released an 81-page request for information on home care and long-term care. The questions cover a universal home care benefit based on functional need, making HCBS mandatory in Medicaid, ending waiting lists, the 80/20 compensation requirement and the companionship exemption. Before Tuesday, the document read like a wish list from the minority party. Now its authors will run the committee with jurisdiction over Medicare and Medicaid. Comments are due Dec. 18. Do you have numbers on authorization hours, waiting lists or what 80/20 does to your margins? Send them, either directly or through your state association.

What stays the same

Medicare home health rates still come from CMS rulemaking, not from Congress. Fleming's advice to providers was to expect "a different tone, but not a change in priorities." Program integrity stays on the agenda too. Advocates told HHCN they support going after bad actors, but they want oversight targeted so compliant agencies don't get caught up in broad enforcement tools. So keep your records tight. Matched plans of care, verified visits and clean documentation protect you no matter who chairs the committee.

That last point is the part CareSync® works on every day, giving office teams a clear view of planned versus completed visits so the record holds up when someone asks. We're also quietly building something separate from the software, an invite-only circle where home health professionals compare notes on shifts like this one. More on that soon, and we hope it helps the field.