Why It Matters

Congress is actively debating Medicaid funding cuts that directly threaten home and community-based services, while demographic pressures and workforce shortages make robust federal investment essential.

The Partnership for Medicaid Home-Based Care’s (PMHBC) shift from a single lobbying firm to a multi-firm strategy—adding Avenue Solutions alongside existing relationships—signals the organization is escalating advocacy efforts in response to heightened legislative and regulatory activity. The stakes are substantial: Medicaid funds over half of all long-term services and supports spending, with six million people relying on Medicaid for long-term services.

Key policy battles shaping PMHBC’s strategy:

  • Medicaid Funding Threats: The One Big Beautiful Bill Act includes provisions that could reduce provider reimbursement and eliminate enhanced funding for expansion states.
  • Regulatory Front: The CMS "Ensuring Access to Medicaid Services" rule’s 80% compensation pass-through requirement faces congressional opposition.
  • Legislative Opportunities: The HCBS Relief Act would increase federal funding for home-based care by ten percentage points.
  • Workforce Crisis: With 4.6 million unfulfilled home care jobs projected by 2032, adequate reimbursement rates are increasingly urgent.

By the Numbers

The Partnership for Medicaid Home-Based Care has spent $1.87 million on federal lobbying over the past decade. After working with Liberty Partners Group LLC from 2015 to early 2022 ($1.3 million), PMHBC transitioned to Akin Gump Strauss Hauer & Feld LLP, spending $570,000 through October 2025.

Now PMHBC has assembled a three-firm team, adding Avenue Solutions for 2025, with veteran lobbyists Tracy Birkhahn Spicer and Matthew C. Fuentes representing the client.

Spicer brings nearly 20 years of healthcare lobbying expertise. She previously served as Deputy Policy Director for the Senate HELP Committee and Deputy Chief of Staff for Senator Ted Kennedy, representing major insurers and home health provider Amedisys Inc.

Fuentes specializes in reimbursement and regulatory policy, currently representing the National Alliance for Care at Home and Help at Home. His Capitol Hill background includes six years in the Senate, including work on the Senate Finance Committee under Senator Chuck Schumer.

The Agenda

The Partnership for Medicaid Home-Based Care is lobbying to protect and expand federal funding for home and community-based services under Medicaid. PMHBC advocates for increased reimbursement rates to support direct care worker wages and expanded access to home-based care as an alternative to institutional settings.

The timing of PMHBC’s expansion to Avenue Solutions reflects urgency around several legislative priorities:

Broader Context

PMHBC is expanding its lobbying efforts amid significant threats to its core mission. The One Big Beautiful Bill Act includes provisions that would reverse the CMS rule requiring 80% wage pass-throughs to direct care workers.

Meanwhile, demographic pressure is mounting. The senior population is projected to exceed the child population by 2034, intensifying demand for long-term care. Yet the industry faces a severe workforce crisis—wages for home health aides average just $16.82 per hour.

Democrats are mounting a defense. Legislators including Senator Maria Cantwell and Ron Wyden are warning that cuts would devastate home care access.

Between The Lines

Congress is actively debating the future of Medicaid home-based care funding and workforce stability. Democrats are vocally defending Medicaid against cuts, with Senator Maria Cantwell warning that cuts would "devastate" long-term care access and Representative Sharice Davids cautioning cuts would worsen provider shortages.

A regulatory front is equally contentious. The CMS "Ensuring Access to Medicaid Services" rule faces congressional opposition and heavy lobbying from competitors like Addus HomeCare and Help at Home.

Competitive Landscape

The Medicaid home-based care advocacy space is crowded with well-resourced competitors. Addus HomeCare and Help at Home—two of the nation’s largest home care providers—are actively lobbying on overlapping issues, particularly the CMS "Ensuring Access to Medicaid Services" final rule.

Notably, Help at Home is also represented by Matthew C. Fuentes—one of the same lobbyists now retained by PMHBC through Avenue Solutions. This overlap underscores intense competition for legislative attention and regulatory influence.

The Bottom Line

The Partnership for Medicaid Home-Based Care is escalating its Washington presence amid existential threats to its sector. The organization’s multi-firm strategy—led by Tracy Birkhahn Spicer, a former Senate HELP Committee official, and Matthew C. Fuentes, who previously worked on the Senate Finance Committee—brings direct access to the two committees controlling Medicaid’s fate. This represents a necessary response to an intensifying policy crisis in long-term care.

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