Senate Democrats Outline Long-Term Care Goals for Future Medicare Expansion

Senate Democrats sent a policy letter to colleagues on Wednesday outlining goals to expand home-based care under Medicare. The letter was sent by Sen. Ron Wyden and 17 other Democrats. It focuses on workforce pay, nursing home quality, and home care access.

The letter describes current long-term care as fragmented and costly. It states that many families face high out-of-pocket expenses. The letter also notes that Medicare covers only short-term skilled care.

Medicaid covers long-term residential and home-based care for eligible low-income people. The letter criticizes recent Medicaid spending reductions. Roughly 1.3 million people lived in certified nursing facilities in 2025. About 25 million Americans live with disabilities that require supportive services. Annual costs for in-home aides averaged $78,000 in 2024.

Democrats attempted to expand home-based care benefits during the 2021 legislative session. Funding for those services was reduced from initial proposals. A later proposal during the 2024 campaign also called for Medicare home care coverage. Democratic staff described the current letter as early planning.

The letter aims to prepare the Senate for potential action after the 2028 elections. It does not include specific cost estimates or implementation details.