Sen. Ron Wyden (D-OR) released a detailed request for information on Friday seeking public and stakeholder input on a universal home care benefit utilizing Medicare and Medicaid. “Long-term care and the decisions that surround it are among the most personal and sensitive any American family must face,” Wyden said in a statement, adding that current decisions are driven too often by financial pressures rather than family needs.
Evaluating Medicare and Medicaid Structures for Universal Coverage
The inquiry asks stakeholders to determine whether a universal home care benefit should be housed within Medicare or Medicaid. If built around Medicare, the document questions what role Medicare Advantage might play. Alternatively, it examines whether leveraging Medicaid through concepts in the HCBS Access Act—such as making home- and community-based services mandatory—offers a stronger framework, or if long-term care should integrate into a Medicare for All program.
Eligibility and benefit scope form another core focus of the inquiry. Wyden asks whether access should rely on a functional assessment of need rather than a specific diagnosis, age, or disability category. Covered benefits could range from Medicare covering a portion of home- and community-based services alongside Medicaid to a set number of care hours per week, month, or year.
Balancing Family Affordability and Generational Wealth
The request for information seeks analysis on cost-sharing structures designed to keep benefits affordable for families. Because many seniors maintain low incomes alongside high assets tied up in their homes, the document asks how affordability standards should account for both income and assets. Specifically, it questions whether housing wealth should factor into calculations in an equitable way that protects generational wealth while discouraging families from shifting assets into housing simply to avoid cost-sharing.
Addressing Direct Care Workforce Protections and Pay
On workforce policy, Wyden requests feedback regarding measures to improve direct care worker compensation, such as the Medicaid Access Rule’s 80/20 provision. The inquiry also broaches efforts to roll back minimum wage and overtime protections for home care workers, pointing to the companionship exemption and a proposed independent contractor rule that would make it easier for employers to classify direct care workers as independent contractors.
“Noting the Republican attacks on LTC workers and their access to basic workplace protections, Senate Democrats request feedback on the reversal of the Trump administration’s rules to roll back minimum wage protections and prevent large corporations from classifying home health aides and direct care workers as independent contractors,” Wyden wrote.
Industry and Advocate Responses to the Senate Inquiry
Home care advocates responded positively to the newly released questionnaire. Patrick Harrison, vice president of policy and legislative affairs, stated that the initiative marks an encouraging step toward expanding accessible care at home for American families, confirming that his organization plans to submit formal comments.
The Home Care Association of America noted that the document provides a significant opportunity for the national trade association and its members to help shape the future of the industry. The organization encouraged members to share practical examples regarding current obstacles and necessary policy changes by emailing feedback to the association.