Long-Term Care Workforce Support Act
- Sponsor
- Rep. Dingell, Debbie [D-MI-6]
- Committees
- Oversight and Government Reform Committee (primary)
- Last action
- Apr 28, 2026
Bottom line
The bill proposes a multi-faceted federal investment and regulatory framework to professionalize and expand the direct care workforce, aiming to improve care quality and worker well-being.
What it actually does
This bill, the "Long-Term Care Workforce Support Act," aims to comprehensively address the crisis in the direct care professional workforce by improving reimbursement for long-term care services, establishing various grant programs for training, recruitment, and career advancement, strengthening labor protections, developing a national compensation strategy, and enhancing oversight. It seeks to increase wages, provide benefits, improve working conditions, and expand the workforce to meet rising demand for care for older individuals and people with disabilities.
Proponents argue
Supporters argue that the direct care workforce is severely underpaid and undervalued, leading to high turnover and critical shortages that negatively impact older individuals and people with disabilities. They contend that this bill's comprehensive approach, including increased reimbursement, training, and labor protections, is essential to stabilize the workforce, ensure access to high-quality care, and address long-standing racial and gender inequities within the profession.
Opponents contend
Critics might argue that the significant federal spending proposed could lead to inflationary pressures or an undue burden on taxpayers. Concerns could also be raised about potential federal overreach into state and local labor markets, the administrative complexity of implementing numerous new grant programs and regulations, and the potential for unintended consequences on care providers, particularly small businesses or individual consumers who self-direct care.
The bill is lengthy and highly detailed, requiring significant time for a thorough review, which may exceed the time typically afforded for public or legislative scrutiny of such comprehensive measures.
Sec. 101, Title I
Medicaid FMAP Increase for Long-Term Care Services
This provision increases the Federal Medical Assistance Percentage (FMAP) by 10 percentage points (up to 95%) for states that meet certain conditions for long-term care services provided by direct care professionals. States must use these additional federal funds to implement activities that improve the direct care workforce, such as increasing reimbursement rates, providing paid leave, hazard pay, and funding training programs. The increase is available for fiscal years 2026 through 2035.
Supporters argue
Proponents argue that increasing the federal share of Medicaid costs is a direct and effective way to incentivize states to invest in their direct care workforce, addressing critical shortages and improving care quality. They believe this financial support is necessary to make direct care jobs more attractive and sustainable.
Critics contend
Opponents might argue that a broad FMAP increase could lead to inefficient spending if states do not effectively target funds to direct care worker compensation and benefits. Concerns could also be raised about the long-term federal budget implications of such a significant and extended increase.
Tradeoffs
The provision balances the need for federal financial support to address a workforce crisis with the challenge of ensuring accountability and effective use of funds by states. It also involves a tension between federal oversight and state autonomy in Medicaid program administration.
Sec. 102, Title I
State Grant Program for Long-Term Care Workforce Support
This section establishes a $100 billion grant program for states, to be awarded by the Secretary of Health and Human Services, to support and strengthen services provided by direct care professionals. States must use these funds to improve long-term care services, recruitment, compensation, and retention of the direct care professional workforce, with specific requirements for salary review processes, passing through payment rate increases to workers, and updating qualification standards.
Sec. 103, Title I
Permanent Spousal Impoverishment Protections for HCBS Recipients
This section makes permanent the Medicaid spousal impoverishment protections for recipients of home and community-based services (HCBS). Previously, these protections, which prevent the spouse of an HCBS recipient from becoming impoverished due to the cost of care, were temporary and subject to expiration. This amendment ensures that a spouse can retain a certain amount of income and assets while their partner receives Medicaid-funded HCBS.
Sec. 104, Title I
Permanent Extension of Money Follows the Person Rebalancing Demonstration
This section permanently extends the Money Follows the Person (MFP) Rebalancing Demonstration program, which helps states transition individuals from institutions (like nursing homes) to home and community-based settings. It appropriates $500 million for each fiscal year after 2026 for the program, ensuring its ongoing funding and impact.
Sec. 202, Title II, Chapter 1
Grants for Supporting the Direct Care Professional Workforce
This section authorizes the Secretary of Health and Human Services to award grants totaling $500 million annually from FY2026-2030 to eligible entities. These grants are for projects aimed at recruiting, retaining, and providing career advancement opportunities for direct care professionals, including managers and self-directed care professionals. Projects must include an advisory committee with diverse stakeholders, assess compensation needs, and provide comprehensive training.
Sec. 206, Title II, Chapter 2
Direct Care Professional Career Advancement Demonstration Projects and Medicare Incentives
This section establishes a $10 million annual grant program (FY2026-2030) for demonstration projects to provide education, training, and career advancement for direct care professionals, prioritizing rural, underserved, and diverse populations. Additionally, it amends the Social Security Act to provide a 25% incentive payment under Medicare for long-term care services furnished by direct care professionals who complete training under these demonstration projects, effective October 1, 2026.
Sec. 207, Title II, Chapter 2
Pathways to Health Careers Through Health Profession Opportunity Grants (HOPG)
This section amends Title XX of the Social Security Act to establish permanent Health Profession Opportunity Grants (HOPG) totaling $425 million annually (FY2026-2030). These grants support career pathways for low-income individuals into various health professions, including direct care. Projects must offer adult basic education, work readiness, training, case management, and supportive services like child care and transportation, with specific guarantees for grantees in each state and for Indian populations.
Sec. 234, Title II, Subtitle D
Direct Care Professional Training Grants
This section reauthorizes and expands direct care professional training grants, appropriating $400 million annually from FY2026-2030 for states, Indian tribes, and tribal organizations. Funds are to be used for wage subsidies, student loan repayment, tuition assistance, guaranteed affordable child care, and transportation assistance for eligible direct care professionals. States must report on changes in workforce numbers, employment duration, wages, and paid time off.
Sec. 235, Title II, Subtitle D
Tax Credit for Certain Health Care Professionals
This section amends the Internal Revenue Code of 1986 to establish a new tax credit of $5,000 for certain health care professionals, including direct care professionals, who provide services in a long-term care setting. This credit applies to taxable years beginning after December 31, 2024.
Sec. 302, Title III, Subtitle A
Long-Term Care Workforce Wage Theft Prevention and Wage Recovery Grant Program
This section establishes a $50 million annual grant program (FY2026-2030) administered by the Secretary of Labor to prevent wage theft and assist direct care professionals in recovering unpaid wages. Grants will support eligible entities (nonprofits, employers, business associations) in activities like educating workers and employers on wage laws, assisting with claim filings, monitoring compliance, and conducting joint investigations with the Department of Labor.
Sec. 312, Title III, Subtitle B
Written Employment Agreements for Direct Care Professionals
This section mandates that covered entities (employers) provide a written agreement to direct care professionals working at least 8 hours per week. These agreements must be in a language understood by the worker, signed by both parties, and include details on responsibilities, pay rates, work schedules, benefits, safety policies, and termination notice. It prohibits mandatory pre-dispute arbitration, nondisclosure, and noncompete agreements.
Sec. 313, Title III, Subtitle B
Fair Scheduling Practices for Direct Care Professionals
This section mandates covered entities to provide direct care professionals with at least 72 hours' notice for any changes to scheduled work hours, including on-call shifts. If less than 72 hours' notice is given for a cancellation or reduction, employers must pay reporting time pay (full regular rate if worker arrives, half regular rate if notified before arrival, with exceptions for emergencies or worker-initiated changes). Workers also have the right to decline schedule changes outside of their agreed-upon hours.
Sec. 316, Title III, Subtitle B
Mandatory Meal and Rest Breaks for Direct Care Professionals
This section mandates that covered entities provide direct care professionals with an uninterrupted 30-minute meal break for every 5 hours worked and a 10-minute uninterrupted rest break for every 4 hours worked. Meal breaks must be paid unless the worker is relieved of all duty and permitted to leave the worksite. Rest breaks are always paid. Exceptions for 'on-duty' breaks are allowed only if relieving duties compromises client health/safety and there's a written agreement, but not for shared living arrangements.
Sec. 321, Title III, Subtitle C
Workplace Violence Prevention Standard for Health Care and Social Services Workers
This section mandates the Secretary of Labor to issue an interim final standard within one year and a final standard within 42 months on workplace violence prevention for employers in health care and social service sectors. The standard requires employers to develop and implement comprehensive workplace violence prevention plans, conduct risk assessments, implement hazard prevention and control measures, establish reporting and investigation procedures, and provide training to employees.
Sec. 332, Title III, Subtitle D
Mandatory Paid Sick Time for Direct Care Professionals
This section mandates employers to provide direct care professionals with at least 1 hour of earned paid sick time for every 30 hours worked, up to 56 hours per year. This time can be used for personal illness, medical care, caring for family members, or issues related to domestic violence, sexual assault, or stalking. Additionally, during a public health emergency, employers must provide extra paid sick time (14 continuous days for full-time, equivalent for part-time) immediately, regardless of accrual.
Sec. 402, Title IV
National Direct Care Professional Compensation Strategy
This section mandates the Secretary of Health and Human Services, in consultation with a newly established National Direct Care Professional Compensation Advisory Council, to develop and regularly update a National Direct Care Professional Compensation Strategy. This strategy will identify recommended actions for federal, state, and local governments, and health care providers to ensure direct care professionals receive a livable wage, considering factors like part-time work, mobility, and equity.
Sec. 501, Title V
Evaluation of Implementation and Outcomes of the Act
This section mandates the Secretary of Health and Human Services, in conjunction with the Secretary of Labor, to contract with an external evaluator to assess the overall implementation and outcomes of the entire Act. The evaluation will cover impacts on workforce creation, training, compensation, working conditions, burnout, vacancy rates, economic effects on care recipients and families, capacity of the workforce, and mental health outcomes, with annual reports on state spending.
Prohibits mandatory pre-dispute arbitration agreements, nondisclosure agreements, and noncompete agreements in the written employment agreements for direct care professionals.
Sec. 312(d)(2), Title III, Subtitle B
Why it matters:This is likely a tactical maneuver to include significant worker protections that might face stronger opposition if presented as standalone legislation. By embedding them within a broader bill focused on workforce support, they may pass with less scrutiny.
Case for: Proponents argue that these prohibitions are essential to protect direct care professionals from exploitative practices, ensuring they can freely pursue legal recourse for grievances and seek better employment opportunities without undue restrictions.
Case against: Opponents might argue that these prohibitions infringe on employers' contractual freedoms and their ability to manage their workforce effectively. They may contend that arbitration offers a more efficient dispute resolution mechanism and that noncompete clauses protect proprietary training or client relationships.
Estimated impact: Significantly alters the legal landscape for employment contracts in the direct care sector, potentially affecting millions of workers and thousands of employers.
Defines immigration-related actions (e.g., reporting or threatening to report immigration status, requesting excessive documents, misusing E-Verify) as discrimination for the purposes of anti-retaliation protections.
Sec. 317(c), Title III, Subtitle B
Why it matters:This is likely a tactical maneuver to provide robust protections for a vulnerable segment of the direct care workforce, many of whom are immigrants. Embedding it within general anti-retaliation language may allow it to pass with less specific opposition than a standalone immigration-focused labor bill.
Case for: Proponents argue that immigrant direct care professionals are particularly vulnerable to exploitation and retaliation due to threats related to their immigration status. This provision is essential to ensure they can exercise their labor rights without fear of deportation or other immigration-related consequences.
Case against: Opponents might argue that this provision could complicate employer compliance with immigration laws or create loopholes for individuals who are not legally authorized to work. They may contend that it oversteps the traditional scope of labor law into immigration enforcement.
Estimated impact: Provides significant legal protection for immigrant direct care professionals, potentially affecting a large portion of the workforce and altering employer practices related to immigration status.
Mandates additional, immediately available paid sick time for direct care professionals during a public health emergency (14 continuous days for full-time, equivalent for part-time), separate from accrued sick time.
Sec. 332(c), Title III, Subtitle D
Why it matters:This provision addresses a specific vulnerability exposed during the COVID-19 pandemic, where essential workers lacked adequate paid leave during health crises. It's a targeted response to a recent, high-profile issue, potentially included to ensure rapid and comprehensive protection in future emergencies.
Case for: Proponents argue that this provision is crucial for protecting direct care professionals and public health during emergencies. It ensures workers can isolate or care for family without financial penalty, preventing further spread of disease and maintaining essential care services.
Case against: Opponents might argue that mandating additional paid sick time during emergencies places an unpredictable and potentially massive financial burden on employers, especially if not fully reimbursed by the federal government. They may prefer more flexible or voluntary employer responses.
Estimated impact: Provides a critical safety net for direct care professionals during public health crises, potentially costing employers billions of dollars depending on the duration and severity of future emergencies.
Provides an incentive payment equal to 25% of the payment amount for long-term care services furnished by a direct care professional who has successfully completed education or training under a demonstration project under section 2008(e) of the Social Security Act, effective October 1, 2026.
Sec. 206(b) (amending Social Security Act, Sec. 1834)
Why it matters:This is a technical amendment to existing law, a common legislative practice. It's also a tactical maneuver to leverage the existing Medicare payment system to incentivize specific workforce development goals, providing a direct financial boost to trained professionals without creating a new, separate grant program.
Case for: Proponents argue that this direct payment incentive through Medicare will encourage direct care professionals to pursue advanced training and improve their skills, leading to higher quality care for beneficiaries. It also recognizes the value of specialized training.
Case against: Opponents might argue that adding a 25% incentive payment to Medicare services could significantly increase program costs without clear evidence that the specific training directly translates to a 25% improvement in value. Concerns could also be raised about the administrative burden of verifying training completion for payment purposes.
Estimated impact: Potentially increases Medicare expenditures by billions of dollars over time, depending on the number of trained professionals and the volume of services they provide. Directly increases compensation for qualifying direct care professionals.