Seventeen Democratic senators are proposing to add home care coverage to Medicare for the first time, along with an expansion of Medicaid home- and community-based services.
The proposed framework, published May 20, centers on creating a Medicare “home care guarantee,” expanding Medicaid home- and community-based services, and strengthening nursing home oversight and the caregiving workforce. While no legislation has been introduced, the senators said specific policy details will follow in the coming weeks and months.
Currently, Medicare does not cover long-term care beyond limited short-term medical services. Medicaid programs are required to cover long-term care in nursing homes, but beneficiaries often must meet strict income and asset thresholds to qualify, and home-based care coverage varies significantly by state.
The senators said their proposals would aim to reduce home care waiting lists, lower out-of-pocket costs, prevent families from having to spend down assets to qualify for services, and make home care a more integrated part of the healthcare system. The letter also outlined potential policies to improve wages, benefits, training and career pathways for caregivers.
The push comes as H.R. 1, signed into law by President Trump in July 2025, cuts nearly $1 trillion in Medicaid spending through 2034. The Trump administration also repealed a Biden-era nursing home staffing rule in late 2025 that would have required facilities to maintain a registered nurse on-site around the clock.
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