Democrats won control of both the House and the Senate on Tuesday, ending two years of unified Republican control of Washington, the same period that produced H.R. 1 and its sweeping Medicaid changes. Several races are still being counted, but we are encouraged by what the results could mean for the people our clients serve.
For organizations that serve Medicaid enrollees, people with disabilities, and older adults, the new majorities will not undo the policies already headed their way overnight, but they do change who is asking the questions in Washington and open new doors for advocates. Here is what we think the results could mean.
What the results could mean
1. More oversight ahead. Frank Pallone and Ron Wyden, the top Democrats on Energy and Commerce and Finance, are in line to chair those committees. We expect hearings and investigations into how CMS is carrying out H.R. 1's Medicaid changes. House Democratic leaders have pledged to reverse the Medicaid cuts and restore the expired ACA premium tax credits, but any repeal still needs President Trump's signature, so these fights will most likely play out in spending bills rather than standalone legislation.
2. January 1 does not move. Medicaid community engagement requirements still begin on January 1, 2027. The one recent shift came from the courts: a federal judge struck CMS's added "significantly impairs" test for medical frailty, so people only need to show they fall within one of the categories in the law.
3. The Administration will lean on what it controls. Without a friendly Congress, we expect CMS to rely even more on rulemaking, guidance, and program integrity enforcement, including payment deferrals and its CRUSH anti-fraud rule, which is pending at OMB. For HCBS providers in particular, comment periods and early engagement with CMS will matter more than ever.
4. The lame duck is the first test. Government funding runs out December 11, and nearly 20 health programs, including community health center funding and several workforce programs, expire December 31. Democrats may push for a short-term fix into 2027, when they hold the majority, while Republicans may want to finish more while they still can.
5. The states matter more than ever. Thirty of the 44 states implementing community engagement requirements elected governors on Tuesday, and those administrations will decide much of how verification and exemptions actually work. In South Dakota, voters rejected an amendment that would have tied the state's Medicaid expansion to the federal funding share.
Looking ahead
Tuesday's results create new opportunities for advocates to be heard. The work ahead is still real, and January 1 is still coming, but organizations that prepare now, build relationships with the incoming committee staff and their new governor's team, and stay ready to weigh in on CMS rules will be in a strong position to protect the people they serve.
If you are thinking through what a new Congress means for your organization, our Federal Advocacy Readiness Checklist is a good place to start, and we are always happy to talk it through. pattersonandmeek.com/get-connected