The Long-Term Care Workforce Support Act, reintroduced in the House of Representatives by Congresswoman Debbie Dingell (D‑MI) on April 28, 2026, aims to address severe workforce shortages across aging services settings through increased federal investment, particularly in Medicaid-funded care.

LeadingAge supports the bill’s overarching goal of strengthening and stabilizing the direct care workforce and has long emphasized that meaningful progress will require substantial and sustained public funding.

At the same time, many of the concerns that LeadingAge raised when the bill was considered last Congress remain relevant.  Though the reintroduced version does include some changes that respond to stakeholder feedback, its core structure is largely unchanged.

As Congress revisits this proposal, LeadingAge continues to engage constructively with policymakers to ensure that workforce investments are workable for providers, support high-quality care, and avoid unintended consequences that could limit access or strain already fragile delivery systems.

Title I: Improving Reimbursement

Title I focuses on Medicaid and seeks to strengthen the long-term care workforce by providing states with a temporary 10 percent increase in the Federal Medical Assistance Percentage (FMAP) for certain long-term care services. The intent is to encourage states to invest more heavily in workforce-related costs, such as improving wages, benefits, training, and working conditions for direct care professionals. LeadingAge has consistently supported the use of Medicaid financing as a central workforce policy tool, recognizing that providers cannot independently raise rates and are dependent on state Medicaid payment decisions to sustain workforce investments. A significant change in the reintroduced bill is the removal of a statutory requirement that a fixed percentage of Medicaid funds be passed directly through to worker compensation. LeadingAge previously raised substantial concerns with that approach, particularly given the lack of cost reporting infrastructure in many Medicaid programs and the risk of unintended effects on service quality and access. The elimination of that rigid threshold is a positive development. Title I, however, continues to rely on a combination of enhanced FMAP and targeted grant funding to advance its workforce goals. LeadingAge believes that the program would be best served by relying more heavily on the enhanced FMAP rather than pairing it with grants. Several of the activities contemplated for these grants involve ongoing responsibilities—such as regular rate review, workforce infrastructure development, and program updates—that require sustained investment rather than one-time funding. These types of costs are generally better supported through Medicaid financing mechanisms than through time-limited grant programs. LeadingAge also continues to flag the risk of a funding cliff created by temporary federal support. Workforce improvements—particularly wage increases—create ongoing obligations that do not end when the FMAP bump expires. Without clear expectations or safeguards around sustaining higher reimbursement levels once the FMAP increase sunsets, providers may again face pressure to absorb costs they cannot afford or to scale back services.

Title II: Training, Recruitment, Career Advancement and Worker Supports

Title II of the bill addresses workforce development more directly through grants aimed at education, training, recruitment, and career advancement for direct care professionals. LeadingAge appreciates the significant level of funding proposed in Title II and agrees that wraparound supports—such as transportation, child care, and educational assistance—are essential to building and sustaining the workforce. At the same time, the grant programs contemplated under Title II remain complex and administratively demanding. Providers, particularly smaller and rural organizations, may lack the capacity to apply for or manage multiple federal grants with distinct requirements, reporting obligations, and timelines. LeadingAge encourages policymakers to simplify and coordinate these funding streams where possible, including by consolidating grant administration under a single federal authority and pairing new investments with technical assistance, particularly for smaller organizations. Without those adjustments, there is a risk that substantial resources could go underutilized or disproportionately benefit organizations with the greatest administrative capacity rather than those facing the most acute workforce challenges.

Title III: Workforce Labor Protections

Title III addresses labor protections for direct care professionals and closely resembles provisions in the bill’s previous iteration. It contains a number of requirements related to scheduling practices, written agreements, paid leave, and workplace safety, along with grant programs and advisory structures tied to compensation and wage compliance. LeadingAge supports direct care professionals and recognizes the importance of policies that promote fair treatment, safety, and stability for the workforce. At the same time, several Title III provisions continue to raise operational concerns for aging services providers. The requirement that employers enter into detailed written agreements with direct care professionals would, in LeadingAge’s view, duplicate information already routinely provided and impose significant administrative burdens while limiting employers’ flexibility to respond to changing circumstances. The fair scheduling provisions require advance notice of work schedules, mandate 72 hours’ notice for schedule changes, and obligate employers to compensate workers when shifts are canceled or shortened. While the bill includes new exceptions intended to ensure flexibility when client or resident health and safety is at risk, LeadingAge remains concerned that the 72-hour notice standard does not adequately account for the realities of care delivery, where acuity and needs of patients evolve quickly, leading providers to triage and reschedule based on patient needs, not regulatory compliance. Title III also includes provisions intended to expedite the development of a federal workplace violence prevention standard through OSHA. LeadingAge appreciates changes that narrow the scope of covered facilities compared to earlier proposals, such as no longer including home and community-based services providers, but continues to emphasize that any federal standard must reflect the diversity of care settings, avoid duplicating existing requirements, and fully account for the cost and administrative burden placed on providers. Finally, the bill would require employers to provide paid sick leave to direct care professionals. LeadingAge agrees that benefits such as paid leave are an important component of workforce stability but remains concerned about imposing new mandates without corresponding funding. Given that Medicaid and Medicare reimbursement often fail to cover existing costs of care, additional unfunded requirements could further strain providers’ ability to serve residents and clients.

LeadingAge will continue to work with Representative Dingell and other policymakers as the Long-Term Care Workforce Support Act moves forward. While the bill reflects important recognition of the workforce crisis facing aging services, its success would ultimately depend on whether new requirements are paired with sustainable funding, thoughtful implementation, and flexibility that reflects the realities of care delivery. We will keep members informed of developments and opportunities to engage as Congress considers this legislation.