The 2026 Midterms Just Flipped Congress: What the New Majority Means for Home-Based Care
The 2026 midterms changed control of Congress, but they did not change home health, home care, or hospice policy overnight. This article explains what advocates say the new majority may focus on, what the October RFI does and does not mean, and why Medicaid rates, CMS rulemaking, veto power, and workforce shortages remain important. It also offers practical steps owners can take to prepare without making assumptions about future policy.
11/5/20266 min read
The 2026 midterm elections shifted control of Congress from Republicans to Democrats, creating potential openings for home-based care policy and a risk of political gridlock. For home health, home care, and hospice owners, the key signal is the October request for information on home and long-term care, not a change in benefits, payment rates, or law today.
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Who this is for
Home health, home care, and hospice owners with $2 million to $10 million in revenue.
Operators reviewing exposure to Medicaid, home- and community-based services, workforce shortages, or a possible sale or succession.
Key takeaways
Advocates say the new congressional majority could bring more attention to home care affordability, Medicaid, and home- and community-based services.
The October request for information, or RFI, is a signal of policy topics under discussion. It is not legislation or an enacted benefit.
President Trump retains veto power, and advocates say legislation will require compromise.
CMS continues to set Medicare home health and hospice payment rates through annual rulemaking.
Owners can prepare by tracking policy activity and keeping payer mix, workforce, and revenue concentration information current.
What changed
The 2026 midterm elections flipped control of Congress from Republicans to Democrats. Home-based care advocates told Home Health Care News that the change could affect which legislation Congress pursues, while also creating the possibility of political stalemate.
Jason Lee, CEO of the Home Care Association of America, said the change could create new opportunities, particularly in light of the RFI. At the same time, he noted that home-based care has historically drawn bipartisan attention. With President Trump able to veto legislation, Lee said, proposals will require compromise.
Advocates have pointed to the Senate Finance Committee Democrats’ October RFI as a guide to topics the new Congress may consider. The RFI is a request for information, not a bill. It describes areas for discussion; it does not establish a new benefit or change coverage rules.
What the RFI tells owners to expect
Advocates cited access to universal, affordable home-based care as a priority reflected in the RFI. Denis Fleming Jr., chief government affairs officer of the National Alliance for Care at Home, said the RFI includes options for a universal home care benefit based on functional need rather than age or income. That is an RFI concept, not an enacted benefit.
The RFI also addressed the Medicaid access rule and its 80/20 provision, according to Lee. Mollie Gurian, vice president of government affairs at LeadingAge, pointed to proposals to reverse Medicaid cuts that threaten home- and community-based services, or HCBS. Together, these topics reflect discussion about both expanding access and protecting existing services.
For owners, the practical point is not to assume a specific policy outcome. Instead, identify which parts of your business could be affected if federal or state policy around Medicaid access, HCBS, or home care benefits changes.
The realistic constraints
Several limits stand between policy discussion and a change in operations:
Legislation requires compromise. Lee said President Trump’s veto power means legislation will need compromise. A new congressional majority does not remove that constraint.
A Medicare home care benefit would take time. Eric Reinarman, HCAOA’s vice president of government relations, described the benefit discussed in the RFI as expensive and said it was “a long road.” He cautioned against expecting it to be enacted anytime soon.
Congress does not set Medicare rates through the annual rule. Fleming noted that CMS continues to set Medicare home health and hospice payment rates through annual rulemaking. Congress may press for action or consider legislation, but the rulemaking process remains important.
Gridlock is possible, not certain. The election creates opportunities for policy activity, but veto power and the need for compromise leave open the possibility of political stalemate.
The October RFI had a December 18 response deadline. That date belongs to the October RFI process. It should not be treated as a new deadline created by the election or incoming Congress.
What is not changing
Program integrity remains a priority, according to Fleming. Advocates have also cautioned against using overly broad oversight tools that could burden compliant providers.
Gurian said oversight should be targeted and effective, protecting beneficiaries while allowing high-quality providers to operate without unnecessary administrative burdens. Lee said Democrats are unlikely to fully align with the Trump administration’s approach to fraud enforcement, and are likely to focus more on the Senate Finance Committee RFI.
Fleming’s advice to providers was to expect “a different tone, but not a change in priorities.” For home health, home care, and hospice owners, that means preparing for continued attention to compliance and program integrity, regardless of changes in congressional leadership.
The workforce constraint
Expanding access to care depends on having enough workers to deliver it. Reinarman said HCAOA is advocating for EB-3 visa reform and a new visa specifically for home care workers, proposals he said have drawn interest from both parties.
But policy changes alone cannot resolve staffing shortages. Expansion would also require sufficient staffing and a workable funding and implementation plan. Reinarman described the workforce crisis as the “rate-limiting factor.”
That is relevant across home care, home health, and hospice. Owners should be ready to explain how workforce availability affects their capacity to serve patients and clients, and what steps they take to recruit and retain staff.
What this means for owners
Federal policy is only part of the picture. Fleming noted that Medicaid rates are set at the state level, so state capitals matter as much as Washington for providers with Medicaid exposure.
A practical monitoring plan can help owners separate policy signals from operational changes:
Buyer diligence and valuation implications
The election does not, by itself, change buyer underwriting math or predict a change in agency multiples. Policy direction may affect assumptions about payer mix and revenue that depends on Medicaid or HCBS, but the proposals discussed in the RFI are not current operating rules.
For an illustration only, an agency with $650,000 in normalized EBITDA at a 5.0 multiple would indicate $3.25 million in value. At a 4.75 multiple, the illustration would indicate $3.0875 million. These are example calculations, not market quotes, a valuation, or a prediction of a policy-driven change in sale price.
Buyers assess the strength and risks of an agency’s operations, including revenue concentration and workforce stability. An owner who can document payer mix, state-level Medicaid and HCBS exposure, staffing, and retention practices gives a buyer clearer information to evaluate under either policy outcome.
What owners can do now
Follow the October RFI and new congressional activity, keeping a clear distinction between discussion, proposed legislation, and enacted policy.
Assess Medicaid and HCBS revenue concentration by state.
Document workforce capacity, recruitment, and retention practices.
Consider submitting comments or participating in association advocacy on issues that affect your agency.
Keep sale-readiness materials grounded in current operating facts, separate from speculation about future policy.
So what should you do now?
Ask your finance lead to summarize payer mix and Medicaid or HCBS exposure by state.
Ask your operations lead to document staffing levels, retention practices, and service capacity.
Assign someone to monitor congressional and CMS activity that directly affects your service lines.
If you are considering a sale or succession, prepare current diligence materials without relying on policy changes that have not happened.
Plain-Language Glossary
RFI: A request for information that gathers input on policy ideas. It is not a law or a bill.
Midterms: Elections held midway through a president’s term that determine seats in Congress.
Chamber control: Which party holds a majority in the House or Senate.
Veto: The president’s power to reject legislation passed by Congress.
HCBS: Home- and community-based services that support people outside institutional settings.
80/20 provision: A provision of the Medicaid access rule discussed in the RFI. The source article identifies it as a topic, not a new requirement enacted by the election.
EB-3 visa: A category of employment-based visa. HCAOA is advocating for reform and a separate visa for home care workers.
EBITDA: Earnings before interest, taxes, depreciation, and amortization.
Normalized EBITDA: EBITDA adjusted to reflect the ongoing operations of a business.
Multiple: A factor applied to EBITDA in an illustrative valuation calculation.
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Senate Healthcare LLC is the buyer and strategic partner pursuing home health or hospice agency acquisitions. We are not a broker or advisor. If you are considering a sale, succession, or partnership, your agency does not need to be perfectly positioned to start a confidential conversation with us. We can discuss your goals, current strengths, areas to address, and whether a potential transaction with Senate Healthcare may be a fit.
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