As a proud member of the Partnership for Medicaid Home-Based Care (PMHC), HCAF is closely monitoring federal policy developments that affect Florida’s home care provider community. These updates include congressional action to avert a government shutdown, new guidance from the Centers for Medicare & Medicaid Services (CMS) on rural health funding, home- and community-based services (HCBS) workforce policy debates, and legislation that could shape the future of long-term care delivery.

Below are key highlights and advocacy opportunities for HCAF members.

Congress Races Against the Clock to Avert Shutdown

The U.S. House of Representatives narrowly passed a continuing resolution (CR) on Friday to temporarily fund the federal government through November 21, 2025, with a 217-212 vote. Developed without Democratic input, the bill includes:

• Increased security funding for federal officials
• A fix for a $1 billion shortfall in Washington, D.C.’s budget
• No continuation of enhanced Affordable Care Act (ACA) subsidies

Meanwhile, the Senate rejected both the House’s bill and a competing Democratic proposal. With Congress now in recess, just days remain to avoid a shutdown on October 1.

Key points of contention include:

• Restoring Medicaid and ACA subsidies (Democratic priority)
• Passing a clean CR with no policy riders (Republican priority)
• Disagreements over rescissions (reclaiming previously allocated funds)

HCAF is closely watching negotiations given the potential downstream impacts on Medicaid and federal health programs.

PMHC Policy Committee Update

PMHC's Policy Committee recently met, during which the following issues were discussed:

• Outlook on Federal Funding & Future Advocacy: While uncertainty remains about the near-term budget path, a smaller “minibus” spending package later this year is expected to include additional funding and potential policy provisions. PMHC plans to share advocacy proposals with congressional staff to keep home-based care on the radar.
• Strengthening CMS Relationships: PMHC continues to build relationships with key leaders at CMS, including Grant Thomas, Senior Advisor to the Center for Medicaid and CHIP Services (CMCS). Following a recent meeting with Acting CMCS Director Caprice Knapp, PMHC shared materials addressing the 80/20 wage requirement in the CMS Ensuring Access to Medical Services final rule and will provide those same materials to the permanent administrator once appointed.
• State Directed Payments (SDPs): Committee members agreed that most action on SDPs is occurring at the state level, and the topic will remain a standing agenda item for updates and intel sharing.
• $50 Billion CMS Rural Health Transformation Opportunity: CMS released details for a new $50 billion program to support state-led rural health transformation initiatives. States have until November 5, 2025, to submit applications, and awards will be announced by December 31, 2025. As part of our ongoing advocacy efforts, HCAF submitted comments this month urging state leaders to enhance access to Medicaid-funded HCBS for Florida’s most vulnerable populations.

Medicaid Trends in 2026 State Budgets

Among the 47 states that finalized fiscal year 2026 budgets:

• Waiver programs were expanded
• At least 13 states funded new behavioral health inpatient beds
• Several states invested in Medicaid workforce stabilization
• States aimed to better align Medicaid funding with local needs

Florida’s 2025-26 budget, signed by Governor Ron DeSantis on June 30, 2025, totals $117.4 billion, including $36.53 billion allocated to the Agency for Health Care Administration (AHCA), which oversees the Medicaid program.

Click here to view the full state-by-state Medicaid budget summary.

MACPAC Weighs HCBS Wage Reporting Mandate

The Medicaid and CHIP Payment and Access Commission (MACPAC) is evaluating a proposal to require states to report hourly wages of HCBS workers (e.g., personal care aides, home health aides) twice per year. Data would be disaggregated by worker type and geography.

PMHC will submit a letter to MACPAC expressing concern that focusing solely on worker wages paints an incomplete picture. We’re advocating for a more holistic approach that reflects rates paid to providers, overhead costs, and sustainability.

New HCBS Workforce Protection Bill Introduced

Federal lawmakers are considering the HCBS Worker Protection Act of 2025 (H.R. 5228), legislation that would make it easier for HCBS workers to access benefits such as health insurance and skills training. Sponsored by U.S. Representative Debbie Dingell (D-MI), the bill would reverse a provision in the One Big Beautiful Bill Act that restricted HCBS workers from making payroll deductions for certain benefits.

Advocates argue that this change is crucial for supporting the direct care workforce and ensuring families have access to stable and quality care. The bill has garnered support from various organizations, including Caring Across Generations, the National Domestic Workers Alliance, the National Alliance for Direct Support Professionals, and labor unions. These organizations emphasize the importance of fair pay, benefits, and job protections for the direct care workforce.

Currently, the measure has 27 Democratic co-sponsors and is under review by the House Committee on Energy and Commerce. While it is viewed as a statement piece with a limited path to enactment, the bill underscores the growing concern for the well-being and support of HCBS workers.

Long-Term Care Advisory Commission Bill Gains Bipartisan Support

U.S. Senators Jacky Rosen (D-NV) and John Boozman (R-AR) introduced the Supporting Our Seniors Act (S. 2762), which would create a 12-member federal advisory commission to study:

• Long-term care delivery and reimbursement
• Access to skilled nursing, hospice, and HCBS
• Workforce challenges across the care continuum

This proposal reflects growing urgency in Congress to address the future of aging in place and long-term supports.

Next Steps

HCAF will continue working through PMHC and the National Alliance for Care at Home to keep Florida’s home care voice at the table in Washington, D.C.

For questions or to get involved in advocacy efforts, please contact Kyle Simon, Senior Director of Policy, Advocacy & Communications, at ksimon@homecarefla.org.