How Immigration, Affordability, and 80/20 Are Reshaping Home Care’s Future (Eric Reinarman)

Eric Reinarman, VP of Government Relations at HCAOA, covers the most pressing policies being talked about on Capitol Hill. From immigration reform and workforce shortages to affordability of care and the controversial 80/20 Medicaid rule, he breaks down what’s happening in Washington and how it could reshape the industry. We also talk about the power of advocacy, why storytelling moves policy forward, and how every provider—big or small—can make their voice heard. Plus, he covers a major win with the Elizabeth Dole Home Care Act and shares practical ways to stay informed and involved at the state and federal level.

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min

Oct 21, 2025

How Immigration, Affordability, and 80/20 Are Reshaping Home Care’s Future (Eric Reinarman)

Miriam Allred (00:00)
Hey everyone, welcome back to the Home Care Strategy Lab. Today in the lab, I'm across from Eric Reinerman, the VP of Government Relations at the Home Care Association of America. Eric, it's a pleasure. Welcome to the show.

Eric Reinarman (00:14)
Miriam, thank you for having me. I'm excited. This is my first podcast actually. yeah, this is my first one. I'm excited.

Miriam Allred (00:21)
First podcast giddy up. was just telling you though, it's a lot like other public speaking. It's just more of the same. We just happen to be recording it as a podcast. So, I have been looking forward to this. You and I, have rubbed shoulders at different events and different things, but I am excited to officially have this one-on-one time to sit down with you and learn from you. And we're just going to tackle some of the hot button items on Capitol Hill in regards to home care. So I'm not going to.

I'm not going to spare you. I'm honestly just going to take it right as it comes and we're going to get right after it. before we do that though, tell everyone a little bit about your background and how you landed in your current role at the Home Care Association of America.

Eric Reinarman (00:49)

Sure, so I'm a recovering attorney as many attorneys are. I've kind of, don't practice anymore. For a while I did some labor law, I did some family law for a while. I worked for the attorney general's office in Florida for a little bit. Now I am government relations specific. So I worked for another association in the hospitality sector before this. know, similar role in terms of.

advocacy and actually some of the issues did overlap with hospitality and work, you know, with workforce and all the other ⁓ issues that are home care is facing now. And I was there for about two or three years and now I'm with the Home Care Association of America. I love it. Love the space. I think I really enjoy the agency owners that I'm able to work with every day. It's a very collaborative industry, which I really appreciate everyone,

There's not a real sense of any cutthroat competition, as there was a little bit of that in hospitality and in home care, it's really a lot more collaborative, which I really appreciate. Everyone is trying to help everybody else and I enjoy that. So I, and here I am. So yeah.

Miriam Allred (02:06)
Amazing. I like what you're saying there about it being very collaborative. think that's what draws me to home care and has allowed me to stay here is there's just a lot of good natured people. And we're all working towards solving the same common goal. There is a supply and demand issue around home care and there is enough demand to go around and we're all trying to chip away at solving that problem in our local market. And that'll kind of bleed through this conversation today is how do we do that and what do we.

How do we accomplish that at like a federal and a state level as well? So like I said, we're going to jump right into some of the topics that you spend a lot of time thinking about. And I think a lot of owners, operators are thinking about as well. But I want to get an update on each of these issues and get a sense of your take on these issues. And then also talk about what providers need to know.

but also what they need to do about this information. So we're going to talk about immigration and expanding the workforce. We're going to talk about affordability of care, bills to watch out for, non-compete, know, FTC, what's happening there, Medicaid 80-20, like we're just going to kind of tackle these big issues. Let's just start with immigration. I think that is on a lot of people's mind. It's in the news. There's just a lot of buzz around this topic. so, um, The big ones. Yeah.

Miriam Allred (03:22)
Home care needs labor and there is a shortage and immigration has often been a labor pool that these home care companies are tapping into. So let's just start with an update on where things are at with that issue.

Eric Reinarman (03:35)
Yeah, it's a timely one right now, obviously. It's always a challenge in Washington immigration reform is, no matter what the political climate is, that's always one that folks are a little bit wary to touch and pick up in terms of elected officials. But for the first time, I think in a while we're seeing genuine bipartisan recognition, if not progress, probably more like I would use a different term recognition that our long-term care system

can't function without more workers, right? We need that. There is a visa category that does apply to home care. It's not specific to home care and caregivers, but there's an EB3 visa, right?

The system is slow, it's clunky, it's outdated. We have met with, for example, the Department of Labor. We've met with, you know, this always comes up in our meetings with elected officials as to how to make that EB3 visa process smoother. There's a lot of really archaic.

hoops you have to jump through in order to qualify. One is you have to post the opening for a caregiver in a newspaper. mean, that's not how people are hired anymore. I mean, that's just not how things work in 2025.

That's just one small example of like why it's so clunky. know, the submission process is just unbelievably slow. It kicks visa applications out for reasons that aren't delineated clearly. So we have, enumerated all of these sort of shortcomings in a white paper and then we presented it to DOL for their portion. It's not all DOL's fault. I don't mean to lean on them too aggressively because they have been very open to discussions with us, particularly recently. So we're very thrilled about

that. But that's just, you know, one way we're looking at it is trying to reform that EB3 process.

We also have drafted our own sort of, it's not really a white paper, but our own home care visa. And it's something we circulate around Capitol Hill. That one would be specific to home care. would not provide a path to citizenship because I think that's a little too fraught right now with the political realities being what they are. That's just not something I think that would be able to get passed right now, but it would be specific to home care. more importantly,

socializes the issue of the fact that we need more workers and we need to address this through immigration. That's one really good way that we can try to address this problem. So we've been leading advocacy for these types of targeted reforms. ⁓

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Miriam Allred (05:59)
Are home care companies taking advantage of the EB3 or is it just so implausible that it doesn't make sense?

Eric Reinarman (06:07)
It's not implausible. do know caregivers that are coming through the EB3 process. It is very slow. It does take a long time. Some of the backlogs can be years. I mean, it's wild. But we do know folks that are having success through EB3. So there's hope there, but I don't want to pretend that

You know we can see we can really see the light at end of the tunnel and that it's going to get better soon. I can't predict that. You know I think that you're seeing on both sides of the aisle the recognition that this is a serious problem that needs to be addressed that will help the economy right? I more caregivers coming here through this process will be you know advantageous to the tax base. It will be advantageous to local economies and the national economy as a whole, you know.

But it's it's tough. There's also a bill. I don't know if you want me to get into that now that we're that we're supporting. But it's it's HR 5494. It's been filed a couple of times before by Rep Smucker out of Pennsylvania. I believe it's the 11th district out of Pennsylvania. That bill is called the Essential Workers for Economic Advancement Act. That would create a new visa category. So.

it would create, I think it's an H2C, I believe the title is, I can't remember exactly, but it would create a new visa category that would be specific for caregivers. It's bipartisan, which is good. I think it's got 10 co-sponsors now, so it's got Dems and Republicans on it. But again,

Right now, the political climate being what it is with immigration being a very controversial topic. Do I see that bill passing in the 119th Congress, which is the Congress we're in right now? Probably not, right?

Miriam Allred (07:48)
And you mentioned a minute ago about a home care visa that you all have been putting together. How long have you been working on that specifically?

Eric Reinarman (07:56)
That's a couple years in the making that one is really drafted to our specifications, right? The age to see would be for a variety of different workers where caregivers would fall under the penumbra of an age to see, but it wouldn't be just for caregivers. The one that we're working on would be just for caregivers that hasn't been filed or anything like that, but really.

The important thing to remember on both of these, both the bill that I just mentioned, Smucker's bill and our home care visa is we're socializing these issues, right? People are getting more more accustomed to hearing about the home care shortage, right? The caregiver shortage, why we need to increase immigration in this particular industry and,

How it can be made easier to get workers in without you You don't even necessarily need legislation if you were to reform the EB3 process that would help a lot so we are making people aware of what a problem this is and ⁓ That's really half the battle because you know when you want to make progress in Washington sometimes it takes multiple Congresses right to in order to actually get something passed because you've got to get everyone familiar with the issue first

Eric Reinarman (09:00)
So that's why it's important to be out front on these types of things. Which speaks to your... Yeah, go ahead.

Miriam Allred (09:05)
Yeah, and I'll continue to ask that throughout this conversation is how long you've been after it and kind of where we are today because the timelines here are all relative. And, if we've been at an issue for two years or four years and where we're at today, because like you just said, things take a long time and it's not just short-term fixes. It's like we're socializing issues. We're creating like long-term solutions and that's nothing that can't happen overnight.

Eric Reinarman (09:31)
That's right. That's right. It really takes time for these electeds and their staff to get used to seeing things come across their desk. Once they do, then it becomes a lot easier to then they start talking about it amongst themselves like, yeah, I know that bill, you know. interesting. Yeah, I remember when we met with HCAOA about that. That's why advocacy is so important. And I know we'll get into that ⁓ a little later. But yeah, it's it's it's crucial that we keep talking about it and keep it keep it, you know, in everybody's ear about this topic.

Miriam Allred (09:58)
Speaking of, I think you said Smucker's bill coming out of Pennsylvania, what if anything can we do to support that or to push that forward?

Eric Reinarman (10:08)
One thing that could be done is you could contact your your congressperson and just give them the the the bill number and the name which is HR 5494 the essential workers for economic advancement act and just say I want I want my you know as a constituent of you know representative X I want you to support this bill this is a good bill we need you know we need this bill here's why and you you tell the story.

Advocacy is all about stories. And explain to them that, you know, look, I'm a constituent, this matters to me, and I think you should support this bill, so cosponsor it so that you can ask your congressperson to cosponsor it. I think that would be the best thing somebody could do.

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