Question 13150 — social and medico-social institutions

Summary

Mr. Pierre Pribetich draws the attention of the Minister of Labor and Solidarity to the deep concerns of stakeholders in the medico-social sector following the announcement on November 14, 2026 by the Prime Minister, confirmed by letter, of a transfer of unified supervision of the medico-social sector to the departmental councils. While the latest information suggests that decentralization reform could ultimately be less ambitious than expected, the lack of response to their open letter addressed to the Prime Minister on November 27, 2025 only increases their concern. Professionals and users of medico-social services fear that this reform, if implemented, would further widen the already marked territorial disparities in the care of disability, old age and home help. Disparities between departments in terms of financing, prices and access to rights are now proven, denounced and risk getting even worse if the management of these skills is left to the sole discretion of local authorities. The creation of the fifth branch of social security, dedicated to autonomy, was precisely aimed at guaranteeing a common base of rights, independent of place of residence. Five years after its establishment, the prospect of a The transfer of these skills to the departments is seen as calling into question this progress, likely to further weaken the most vulnerable people. The examples of already decentralized systems, such as the personalized autonomy allowance (APA) or the disability compensation benefit (PCH), illustrate the risks of such a reform: their management today depends more on budgetary constraints local areas rather than an objective assessment of needs. Likewise, the partial recentralizations of active solidarity income (RSA) initiated by several departments, by retransferring this competence to the State, reveal the limits and risks of such transfers. These recentralizations highlight the increased territorial disparities and the budgetary constraints weighing on local authorities, thus confirming the dangers decentralized management for essential social services. In this context, the MP wishes to know whether the Government intends to maintain this transfer project or, on the contrary, initiate an ambitious national project to strengthen the Autonomy branch, by guaranteeing balanced governance, multi-annual programming of resources and working towards an effective reduction of territorial inequalities. He asks her to please specify the measures envisaged to preserve the principle of national solidarity and ensure each citizen, whatever their department, equitable access to quality support. Finally, he would like to know the reasons for the lack of response to the open letter of November 27, 2025 sent by all the organizations representing medical-social establishments and services and the Government's intentions. to reassure players in the sector.

Machine translation from French. The official text remains authoritative.

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