WASHINGTON, D.C. — Senate Democrats released a policy roadmap on May 20, 2026, calling for a “home care guarantee for people with Medicare” — a proposal that would represent the federal program’s first new benefit since the creation of Medicare Part D prescription drug coverage more than 20 years ago.
Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) led the effort, co-signing a strategy letter with 16 Democratic colleagues. The plan calls for expanded coverage of custodial in-home care — the daily assistance with bathing, dressing, and mobility that currently falls outside Medicare’s scope — along with stricter nursing home staffing standards and additional Medicaid funding for long-term care programs.
What the Proposal Includes
The roadmap outlines three broad goals: establish a home care benefit within Medicare, invest in the long-term care workforce, and increase federal Medicaid spending for home- and community-based care services.
Wyden and colleagues framed the proposal around affordability, stating the goal is ensuring that “middle-income families can access care without depleting their savings” — a demographic that often earns too much to qualify for Medicaid but cannot absorb out-of-pocket long-term care costs, which average roughly $78,000 per year for in-home aide services, according to industry estimates. Full-time skilled nursing facility care averages approximately $128,000 annually.
The senators’ letter also calls for policies to increase wages for care workers, embraces immigration pathways for long-term care workers, and includes protections for family caregivers.
What Is Not in the Plan
Democratic staff described the May 20 letter as preliminary brainstorming rather than finished legislation. The roadmap does not include cost estimates, a funding mechanism, or a detailed implementation timeline.
Washington Examiner reported that the senators envision legislation materializing in 2028, contingent on Democrats winning the White House and both chambers of Congress. STAT News, which reviewed the proposal, noted it was released in part to draw a policy contrast with Republican positions ahead of midterm elections.
The Coverage Gap the Plan Would Fill
Currently, Medicare covers skilled home health visits — nursing care, physical therapy, and certain medical services — and post-acute skilled nursing facility stays of up to 100 days. The program does not cover custodial care, which accounts for the majority of long-term care demand.
State Medicaid programs are required to cover institutional nursing home care, and states have the option to fund home-based custodial services for eligible low-income beneficiaries. Private long-term care insurance covers the gap for some higher-income Americans, but enrollment has declined sharply as premiums have increased.
An estimated 1.3 million Americans lived in nursing facilities in 2025, according to federal data cited by STAT News. Roughly 25 million Americans with disabilities require some form of supportive services.
What It Would Mean for Providers
Extending Medicare into custodial home care would require home care agencies to develop a fee-for-service billing infrastructure most have never needed, according to reporting by Home Health Care News. Medicare home health billing currently applies to skilled services only; custodial care has no standardized federal documentation framework or claims adjudication pathway.
The proposal arrives against a backdrop of significant workforce strain. Long-term care has shed nearly 229,000 caregivers since February 2020, according to federal labor data. The median hourly wage for long-term care workers stands at $15.22 — compared to $20.07 for the broader U.S. workforce — a gap the senators’ workforce provision seeks to address.
Historical Context
Senate Democrats attempted to expand home- and community-based care funding in 2021 under the Biden administration’s Build Back Better legislative package. That effort proposed roughly $400 billion for home care expansion; the final version of the legislation, which did not pass the Senate, had been reduced to approximately $150 billion for that purpose.
The new roadmap does not specify a dollar figure for the Medicare home care guarantee.
Why This Matters for Home Care
A Medicare home care benefit, if enacted, would fundamentally change how millions of families access and pay for in-home support — opening coverage to a broad middle-income population that currently navigates long-term care costs largely on its own. For home care providers and the families who depend on them, the policy debate reflects the growing recognition that the home, not the facility, is where most Americans want to age.
For families already providing care at home, the gap between what Medicare currently covers and what daily home care actually requires falls on caregivers and the equipment surrounding a person. SonderCare’s Aura line of home hospital beds — certified to International Hospital Standard, with FallSafe ultra-low heights of 10 inches and full positioning including Trendelenburg and Zero Gravity — is designed to close that practical gap, supporting safe repositioning, fall prevention, and caregiver ergonomics in a residential setting.
If your family is navigating in-home care now and can’t wait for policy to catch up, explore SonderCare’s home hospital beds at sondercare.com/beds or speak with a care specialist who can help match the right configuration to your loved one’s needs.
Sources: Home Health Care News, Washington Examiner, STAT News, Fierce Healthcare