WASHINGTON — Seventeen U.S. senators, led by Senate Finance Committee Ranking Member Ron Wyden (D-Oregon), released a “Dear Colleague” letter on May 20, 2026, calling for a new Medicare benefit that would cover home care for seniors and people with disabilities — a change that would mark the program’s most significant expansion since the creation of Medicare Part D in 2006.
The letter, co-signed by 16 Democratic and Independent senators including Sens. Elizabeth Warren (D-Massachusetts), Tammy Duckworth (D-Illinois), and Tim Kaine (D-Virginia), outlines three goals: establishing what the senators call a “home care guarantee” for Medicare beneficiaries, improving nursing home quality through aligned incentives, and strengthening the long-term care workforce through higher wages and staffing standards.
“Too many American families go to sleep at night worried about how they will pay for a loved one’s care,” Wyden and his colleagues wrote in the letter. “American families are forced to navigate a confusing, fragmented long-term care system filled with gaps, complexities, and staggering price tags.”
The Coverage Gap Medicare Has Never Filled
Medicare currently does not cover custodial care — the daily assistance with bathing, dressing, and mobility that represents the bulk of long-term care needs. The program covers only short-term skilled nursing care following hospitalization and limited skilled home nursing visits. Medicaid covers long-term residential and home-based care, but eligibility requires beneficiaries to exhaust most of their personal assets first.
The senators cited the financial toll on middle-class families: in-home health aide services cost approximately $78,000 per year, while a private nursing home room runs about $128,000 annually. Nearly 70 percent of Americans turning 65 will require some form of long-term care, according to figures cited in the letter. There are currently 1.3 million people in certified nursing facilities and an estimated 25 million Americans living with disabilities.
“In the richest country in the world, the sticker prices for long-term care devastate families,” the senators wrote.
Industry Sees Potential — With Conditions
Home care industry leaders welcomed the proposal’s direction but said the details of implementation would determine whether it delivers on its promise.
Jason Lee, CEO of the Home Care Association of America, called the proposal a significant policy shift. “For providers, it could create a more consistent pathway to serve Medicare beneficiaries who need help with activities of daily living and other non-medical supports that allow them to remain safely at home,” Lee said.
Lee added that any Medicare home care benefit “would have to be designed to reflect the real cost of delivering care,” requiring what he described as “adequate reimbursement, reasonable administrative requirements, clear eligibility rules, and recognition of the workforce challenges providers are already facing.”
Damon Terzaghi, vice president of Medicaid and Home Care Policy at the National Alliance for Care at Home — which represents more than 10,000 home- and community-based services organizations — said the proposal could bring significant structural benefits. A Medicare home care benefit “could lead to more comprehensive, coordinated care, increased system efficiency and improved service delivery,” he said.
Terzaghi also highlighted a key equity dimension. “This would be a great advancement for beneficiaries who currently have to divest themselves of assets in order to access long-term services in the community,” he said.
Workforce and Political Headwinds
The senators framed the proposal against a backdrop of a deteriorating long-term care workforce. The long-term care sector has lost nearly 229,000 caregivers since February 2020, according to data cited in the letter. Eighty-seven percent of nursing homes report moderate to high staffing shortages, and 61 percent have limited new admissions as a direct result.
Polling data cited by the senators shows broad public support: 55 percent of likely voters strongly support Medicare home care expansion, with another 33 percent somewhat in support. The senators noted that 86 percent of Republicans polled at least somewhat support a home health benefit.
Despite that support, the proposal faces steep political obstacles. With Republicans controlling both the House and Senate, senators and analysts described the current letter as “early brainstorming rather than concrete policy proposals.” No specific funding mechanisms or reimbursement rates have been proposed. The senators described 2028 — contingent on Democrats winning a governing majority — as a target for potential implementation.
The proposal echoes earlier Democratic efforts: former President Joe Biden’s 2021 Build Back Better legislation proposed $400 billion for home care, which was ultimately reduced to $150 billion focused on waiting list reduction and worker pay. Former Vice President Kamala Harris proposed a similar Medicare at-home benefit during the 2024 presidential campaign.
For home health operators, any future expansion would require building billing infrastructure for care that, as analysts note, has “never had a standardized federal documentation framework or claims adjudication pathway” within Medicare.
Why This Matters for Home Care
For the millions of families currently financing home care out of pocket, the Senate proposal underscores just how large the gap between Medicare’s existing coverage and actual long-term care needs remains. If enacted, the framework would reshape how families plan and pay for aging in place — but with implementation contingent on a future political shift, families cannot count on federal coverage arriving soon. For families setting up home care environments, resources like SonderCare’s home hospital beds can help bridge the gap between clinical care and comfortable home-based recovery.
