A leading Senate Democrat is exploring a major expansion of Medicare that could help older Americans and people with disabilities pay for long-term care at home. Ron Wyden, the ranking Democrat on the Senate Finance Committee, released a request for information on Friday for feedback on options to overhaul America's long-term care system. He floated the idea of establishing a new Medicare home care benefit as well as expanding access to home care through Medicaid.
Improving nursing-home care and strengthening the overall long-term care workforce were also priorities in his request. Today, those decisions are too often driven by financial considerations rather than what is best for a loved one and their family,” Wyden said. The request is part of Wyden's larger effort to develop Democrats' future health care agenda.
If ultimately enacted, a broader Medicare home care benefit would mark a significant change from current coverage. Medicare pays for certain medically necessary home health services for eligible beneficiaries, but it generally does not cover round-the-clock home care. Medicare covers certain skilled nursing, therapy and home health aide services for eligible beneficiaries, but home health aide coverage is available only when a beneficiary is also receiving qualifying skilled services.
Medicare specifically does not pay for 24-hour home care or home meal delivery. Medicaid, on the other hand, is the country's primary payer for long-term services and supports and accounts for more than half of U.S. long-term care spending, according to KFF. That means many middle-income families are facing substantial costs if they need ongoing help but don't qualify for Medicaid.
The national median cost of a non-medical caregiver reached $35 per hour in 2025, or $80,080 annually based on 44 hours of care a week, according to CareScout's latest Cost of Care Survey. Wyden's Finance Committee staff is asking for feedback across three broad areas: For home care, the document considers multiple routes rather than presenting a single finished legislative proposal. One avenue would involve establishing a new Medicare home care benefit.
Another involves using Medicaid to create a universal home care benefit. I look forward to creative, robust and thorough responses that put Americans who need long-term care at the center." The major difference for beneficiaries would be whether Medicare takes on a larger role in paying for ongoing home-based support. Medicare already has a home health benefit, but it isn't a comprehensive long-term care benefit.
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