A Universal Home Care Benefit Is on the Table: What the Senate RFI Asks Agencies

A universal home care benefit moved from talking point to formal question last week. On Oct. 16, Senate Finance Committee Ranking Member Ron Wyden released an 81-page request for information on long-term care, asking providers, states, families and advocates how a home care guarantee for Americans could actually work. It is a request for ideas, not a bill, but it is the most detailed public outline yet of what a national home care benefit might look like, and comments are open through Dec. 18, 2026.

What the universal home care benefit RFI asks

The home care section covers the questions agencies live with every day. Should the benefit sit in Medicare, Medicaid, or split across both? If Medicare, what role would Medicare Advantage plans play? Should eligibility be based on a functional assessment of need instead of a diagnosis, age or disability category? Would coverage be a set number of hours per week or month, and how would cost-sharing stay affordable for families with modest incomes but home equity? The RFI also asks whether to build on the HCBS Access Act, which would make home and community-based services a mandatory Medicaid benefit and end capped waiver slots and multi-year waiting lists.

The pay and network questions

A second section looks at how the field gets paid. It asks for feedback on the 80/20 provision in the 2024 Medicaid Access Rule, which requires at least 80% of Medicaid payments for homemaker, home health aide and personal care services to go to direct care worker compensation. It also asks how reimbursement rates should be set, whether by program or by agency, against a payment benchmark, with regional differences, and with credit for skills and experience. And it asks what incentives would build a provider network large enough to deliver a universal benefit at all. Committee staff say the document draws on more than 95 listening sessions with about 180 organizations.

Why agency input matters here

Requests like this shape the drafts that follow, and the people who answer them are often national associations and large systems. Smaller home care and home health agencies see things those groups can miss: how long a functional assessment really takes, what a realistic hours-per-week benefit looks like in a rural county, or how a payment benchmark would land against your actual cost per visit. If you plan to comment, it helps to bring numbers you already track, such as planned versus completed visits, authorized versus delivered hours, and where documentation gaps slow down billing. Send written comments to homecare@finance.senate.gov and name the RFI section you are answering.

Whatever comes of the proposal, the questions it raises are useful ones to answer for your own agency now. Clear visit records and a simple view of what was planned versus what actually happened make it easier to speak up with evidence, whether to a Senate committee, a state Medicaid office or a managed care plan. That kind of visibility is what we are building into CareSync®, and it is worth having no matter which way the policy goes.