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Home Health Care News

77 stories

Industry·2d ago

Home Care Providers Expand Dementia, Behavioral Health Offerings

In an HHCN+ members-only analysis, Home Health Care News reports that dementia care and behavioral healthcare are shifting from niche differentiators to baseline expectations for home-based care providers serving older adults. The piece cites examples including HomeWell Care Services exploring expanded dementia support, VNS Health's Dementia Care at Home program launched in 2023, Empath Health's new dementia education program in Florida, and specialist firms like Author Health building businesses around older adults' behavioral health needs. The author argues providers don't need to own these service lines outright but must have a credible plan, internal training, partnerships, or specialized programs, to address cognitive and behavioral health needs as more patients aim to age in place. No regulatory action or new policy is announced; the piece reflects industry strategy trends.

Industry·4d ago

Modivcare Names Marsha Ramos CEO of Personal Care Unit

Home Health Care News reports that Modivcare has appointed Marsha Ramos as CEO of its personal care division. Ramos points to a potential Medicare home care benefit as a possible turning point for the personal home care industry, while cautioning that fraud, waste, and abuse concerns could undermine momentum for such a benefit. She also flagged near-term priorities around sustainable growth for the home-based care segment. The piece is drawn from an interview covering her outlook on industry direction and reform.

Federal Policy·4d ago

Bipartisan Bill Would Make PACE a Mandatory Medicaid Service

Reps. Debbie Dingell (D-Mich.) and John Moolenaar (R-Mich.) introduced the PACE Access Improvement Act on Sept. 24, which would make the Program of All-Inclusive Care for the Elderly a mandatory Medicaid service rather than a state option. The bill also aims to ease requirements so PACE providers can expand in-home care access. States currently choose whether to offer PACE, which serves frail, dual-eligible seniors who qualify for nursing home care but wish to remain in the community. If enacted, the measure would require all state Medicaid programs to cover PACE, likely spurring growth in the number of PACE organizations and enrollees nationwide.

Industry·5d ago

SCAN Health Plan Bypasses Hospital Stays Before SNF Admission

SCAN Health Plan is eliminating the requirement that members undergo an inpatient hospital stay before transitioning from home to a skilled nursing facility, according to Home Health Care News. Some payers require a two-day hospital stay before authorizing a SNF transition, but SCAN is moving toward direct home-to-SNF pathways when appropriate. The move reflects a broader trend of home-based care providers gaining more influence over care-pathway decisions traditionally controlled by hospital-centric authorization rules. While SCAN's Medicare Advantage plans are the direct focus, the approach signals a model Medicaid managed care organizations covering dual-eligible and LTSS populations may watch closely.

Industry·8d ago

Home-Based Care Providers Deploy AI, Outreach to Address Referral Bottlenecks

Home-based care providers report that referral processing, maintenance, and development remain persistent operational challenges, according to industry leaders interviewed by Home Health Care News. Companies are responding with AI-powered tools, clinician-led outreach initiatives, and strengthened relationships with franchise owner-operators to streamline referral workflows. These operational adjustments aim to reduce administrative friction in care coordination. For Medicaid managed LTSS and home and community-based services programs relying on home-based care networks, improvements in referral efficiency may affect network adequacy and care access.

Industry·9d ago

Aveanna, Addus, and Pennant Discuss 2027 Growth Strategies at Jefferies Conference

Three publicly traded home-based care providers — Aveanna Healthcare, Addus HomeCare, and the Pennant Group — presented at the 2026 Jefferies Healthcare Services and Technology Conference, outlining their growth strategies for 2027 beyond new patient referrals. The presentations occurred last week and focused on how the industry's largest operators plan to expand. These companies serve Medicaid beneficiaries through home health, personal care, and related services, often under managed care contracts or state Medicaid programs. Their growth strategies will affect LTSS service capacity, provider network adequacy, and care delivery models in Medicaid managed care.

State Policy·NY·9d ago

190,000 New York CDPAP Caregivers File for Union Election with 1199SEIU

Caregivers in New York's Consumer-Directed Personal Assistance Program (CDPAP) have filed for a union election with 1199SEIU United Healthcare Workers East. If successful, 190,000 self-directed Medicaid home care workers would join the union. The filing sets the stage for a vote that could reshape labor relations in New York's largest self-directed personal care program. For Medicaid managed care plans administering CDPAP benefits, unionization could affect caregiver wage rates, contracting terms, and administrative costs tied to CDPAP services.

Industry·FL·11d ago

Empath Health Launches Dementia Training Program Across Nine Florida Counties

Empath Health, a Florida home-based care provider, launched an immersive dementia education program in early September covering nine counties. The program trains professional care teams and first responders while providing support for family caregivers. It aims to reduce avoidable hospitalizations and improve crisis management for patients with dementia-related cognitive decline. The initiative addresses both workforce training and caregiver support gaps in community-based dementia care.

Industry·13d ago

Home Care Agencies Urged to Pilot AI Tools Before Deployment to Avoid Operational Risks

Home care agencies face growing risks from adopting unvetted artificial intelligence and other technologies without thorough evaluation. Industry experts recommend piloting tools in limited settings before full deployment, scrutinizing vendor contracts for liability and performance terms, and demanding evidence-based proof of efficacy claims. Poor technology choices can result in operational disruptions, compliance gaps, and unexpected costs. The guidance targets agencies serving populations including Medicaid LTSS beneficiaries.

Industry·16d ago

Addus HomeCare Acquires AccentCare Personal Care Business in Home Care Consolidation

Addus HomeCare Corp. is acquiring nearly all of AccentCare's personal care business, significantly expanding Addus's personal care scale while allowing AccentCare to focus on home health, hospice, and palliative care. The transaction marks a strategic shift for AccentCare toward more concentrated service lines and potentially increased focus on health system joint ventures. The deal reflects ongoing consolidation in the home care sector, which serves significant Medicaid long-term services and supports populations. Financial terms and expected closing date were not specified in available reporting.

State Policy·CA·16d ago

California Medicaid Rate Increase Expected to Shift Pediatric Care to Home Settings

California implemented a Medicaid rate increase for home-based pediatric care, prompting Aveanna Healthcare to raise caregiver wages and plan January recruiting expansion. The company anticipates hundreds of families will transition medically complex children from institutional settings to home care as a result of improved reimbursement. The rate adjustment addresses longstanding workforce shortages in California's home health sector by enabling providers to offer competitive wages. This shift affects California's Medicaid program, pediatric providers, managed care organizations with LTSS responsibilities, and families of children with complex medical needs.

Industry·18d ago

Addus HomeCare to Acquire AccentCare Personal Care Division for $275 Million

Addus HomeCare Corporation announced a $275 million acquisition of AccentCare's personal care division, expected to close in Q1 2027 at the earliest. The transaction is part of Addus's broader expansion strategy and will provide the company entry into new geographic markets. The deal represents strategic alignment as both companies focus on their core business lines. Addus executives have indicated additional large acquisitions are in the pipeline.

Legal·18d ago

Home-Based Care Providers Face Heightened Medicaid Program Integrity Oversight Amid AI Adoption

Home health and home-based care providers are experiencing increased Medicare and Medicaid program integrity scrutiny while navigating AI technology implementation. Providers are advised to prioritize AI governance, compliance protocols, and vendor management to mitigate regulatory risk. Recommended actions include conducting internal data reviews and compliance audits. The guidance addresses operational risks for providers serving Medicaid beneficiaries under heightened federal and state oversight of billing, documentation, and technology use.

Industry·19d ago

Addus HomeCare to Acquire AccentCare Personal Care Division for $275 Million

Addus HomeCare Corporation will acquire AccentCare's personal care division outside New York for approximately $275 million. The transaction covers operations in 10 states serving approximately 13,700 clients daily and expands Addus into six new states: Colorado, Georgia, Minnesota, Pennsylvania, Tennessee, and Washington. The acquisition consolidates personal care market share among home and community-based services providers serving Medicaid beneficiaries, particularly in long-term services and supports programs. Financial and regulatory closing terms were not disclosed in the announcement.

Legal·NY·23d ago

Brooklyn Home Health Owner Sentenced to 76 Months for $64M Medicaid Fraud Scheme

A Brooklyn federal court sentenced Zakia Khan, owner of adult day and home health companies, to 76 months in prison for orchestrating a multiyear Medicaid fraud and illegal kickback scheme. Khan pleaded guilty in 2025 to conspiring to defraud Medicaid and pay healthcare kickbacks, fraudulently billing the program approximately $64 million. The sentence was handed down Wednesday, September 9, 2026. This case underscores heightened federal enforcement against Medicaid fraud in home health and adult day services, particularly schemes involving fiscal intermediaries and kickback arrangements.

Federal Policy·24d ago

Home Health Groups Urge CMS to Let Medicare Enrollment Moratorium Expire

LeadingAge and the National Alliance for Care at Home submitted letters asking CMS not to extend the Medicare home health enrollment moratorium as its expiration approaches. The groups, including LeadingAge which previously supported the freeze, are now calling for more targeted enforcement measures instead of a blanket moratorium. The moratorium has restricted new Medicare-certified home health agencies from entering the market. The shift reflects provider concerns that broad enrollment freezes limit beneficiary access while failing to address fraud effectively.

Federal Policy·27d ago

Alliance Official Cites Bipartisan Congressional Support for Home-Based Care Expansion

Denis Fleming Jr., the National Alliance for Care at Home's new chief government affairs officer, reports growing bipartisan congressional support for home-based care policy. Fleming describes the current legislative environment as unprecedented for home and community-based services providers. The Alliance is monitoring both opportunities for policy expansion and emerging access barriers. This development signals potential federal legislative action on HCBS, which could affect Medicaid LTSS delivery models and managed care network adequacy requirements.

Industry·CA·27d ago

24 Hour Home Care to Lay Off 738 Employees Following Health Net Contract Loss

24 Hour Home Care will lay off 738 employees effective September 15, 2026, according to a California WARN notice. The layoffs result from Health Net's planned discontinuation of personal care and homemaker services. The workforce reduction affects a home care provider serving Medicaid beneficiaries who rely on personal care services, typically covered under LTSS benefits in managed care contracts. The layoffs signal potential network adequacy concerns for Health Net's Medicaid line of business if personal care services are not transitioned to alternative providers.

Industry·30d ago

UnitedHealth Group Eliminates Prior Authorization for 1,700 Service Codes Effective October 1

UnitedHealth Group will eliminate prior authorization requirements for approximately 1,700 service codes, including home healthcare services, effective October 1, 2026. The change builds on the company's May 2026 commitment to reduce prior authorization volume by 30% by year-end. The elimination affects services across UnitedHealth's commercial and Medicare Advantage lines. Providers delivering these services will no longer need to obtain advance approval from UnitedHealth plans, potentially reducing administrative burden and accelerating care delivery for affected members.

Managed Care·FL·30d ago

Florida Health Plan Highlights Operational Requirements for Self-Directed Care Programs

Independent Living Systems, a Florida-based health plan serving Medicaid long-term care enrollees, discussed the operational complexities of administering self-directed care when it transitioned to plan status in 2018. The plan required specialized administrative partnerships to support participant-directed services within Florida's Medicaid LTSS program. Self-directed care allows enrollees to manage their own services and supports, but requires health plans to build infrastructure for enrollment, budgeting, and compliance. The article addresses common misconceptions and operational realities for plans administering these programs.

Industry·32d ago

Referral Partners Balance Home Health and SNF Placements to Reduce Readmissions

Post-acute care referral partners are refining site-of-care decision-making to route patients appropriately between home health, skilled nursing facilities, and other settings. The focus is on matching patient needs with the right post-acute setting to prevent costly hospital readmissions. Effective placements require thorough documentation and communication across hospitals, SNFs, and home health agencies. The approach affects discharge planning workflows and care coordination for Medicare and Medicaid beneficiaries moving from acute to post-acute care.

Federal Policy·36d ago

Home Health Providers Submit Comments on CY 2027 Rate Rule

Home health providers and advocates are submitting comments on CMS's proposed home health payment rule for calendar year 2027 as the comment period closes. Stakeholders have expressed support for the proposed rate increase while raising concerns about specific provisions. The rule would take effect January 1, 2027. For Medicaid managed care plans contracting with home health agencies, rate changes at the Medicare level often influence provider cost expectations and contracting leverage in Medicaid networks, particularly for dual-eligible populations and states with integrated care models.

Managed Care·36d ago

States Consider Value-Based HCBS Contracts to Avoid Benefit Cuts During Economic Downturn

Industry leaders at Home Health Care News' PAYER Summit in June said state Medicaid programs facing budget pressure from economic downturns could pursue value-based contracts with home- and community-based services providers rather than restricting benefits or cutting services outright. The strategy shifts financial risk to providers while preserving access. No specific states or implementation timelines were identified. This approach matters for HCBS providers and managed care organizations managing LTSS populations as states seek budget-neutral alternatives to traditional cost containment.

Industry·39d ago

Home Health M&A Activity Increases After Four-Year Decline

Home health and hospice merger and acquisition activity is increasing after four consecutive years of decline. Industry analysts expect the proposed CY2027 home health rule and Medicare enrollment moratoria to drive further dealmaking through 2027. Transaction volume and valuations are both projected to rise. The trend affects home health agencies operating in Medicaid programs, particularly those serving dual-eligible beneficiaries or those considering consolidation strategies.

Industry·39d ago

Home-Based Care Referrals Shift to Performance Metrics Over Relationships

Health systems and payers are increasingly steering patients to home health and home care agencies based on documented performance metrics rather than traditional referral relationships, according to industry leaders speaking at a recent Home Health Care News webinar. The shift prioritizes agencies that can demonstrate quality ratings, low hospitalization rates, fast patient acceptance times, broad payer network coverage, and capacity to manage complex cases. This trend affects how Medicaid managed care organizations and health systems select post-acute care partners and may influence which home health providers maintain or lose patient volume. The change reflects broader value-based care adoption and risk-based contracting in home-based services.

Managed Care·39d ago

Medicare Advantage Plans Denied 12% of Prior Authorizations in 2025, KFF Finds

Medicare Advantage, Medicaid managed care, and ACA Marketplace plans denied between 12% and 18% of standard prior authorization requests in 2025, according to a KFF study. Denial rates varied widely among the largest insurers. The study highlights prior authorization burdens on providers, including home health agencies. The findings are current as of 2025 data.

Legal·40d ago

Home Health Providers Emphasize Compliance Amid CMS and DOJ Fraud Enforcement

VNA Health Group and Empath Health are reinforcing quality documentation, oversight, and compliance protocols in response to intensified anti-fraud enforcement by CMS and the Department of Justice targeting the home health industry. The providers report focusing on communication strategies to clarify their existing compliance models as enforcement activity increases. The crackdown affects home health agencies providing services under Medicare and Medicaid, with providers emphasizing documentation integrity and proactive oversight to mitigate fraud and abuse risk.

Industry·44d ago

Four Major Home Care Companies Deploy Technology to Address Workforce Shortages

Four publicly traded home care providers—Aveanna Healthcare, BrightSpring Health Services, The Pennant Group, and Addus HomeCare—emphasized technology investments as a staffing solution during recent earnings calls. The companies are deploying digital tools to improve caregiver recruitment, retention, and scheduling efficiency amid ongoing workforce challenges in home-based care. While Medicaid finances the majority of home care services nationally, these technology strategies focus on operational efficiency rather than reimbursement-driven initiatives. The developments reflect industry-wide efforts to sustain care delivery capacity in a tight labor market.

Industry·44d ago

Cityblock Acquires Rural Provider Homeward Health, Closes $116M Series E

Cityblock announced a definitive agreement to acquire Homeward Health, a rural-focused healthcare company offering virtual and in-home services, in an all-stock transaction. The acquisition coincides with Cityblock's closure of a $116 million Series E funding round. The deal was announced Thursday in a blog post by Cityblock CEO Toyin Ajayi. The transaction brings together Cityblock's urban-focused Medicaid managed care model with Homeward Health's rural care delivery infrastructure.

Industry·46d ago

VNS Health Virtual Caregiver Coaching Program Cuts Hospitalizations for Heart Failure Patients

VNS Health's Center for Home Care Policy & Research reports that its virtual caregiver coaching program for informal caregivers of heart failure patients reduced hospitalizations and improved quality of life. The program helps caregivers manage stress and improve self-care for the patients they support. The initiative demonstrates potential cost savings through reduced acute care utilization. The finding is relevant for Medicaid programs that cover substantial home and community-based services and long-term care populations where caregiver support affects institutional utilization.

Industry·46d ago

Home Care Providers Adapt Operations for Higher-Acuity Post-Acute Discharges

Home care providers are receiving more referrals of clients with higher acuity needs following shorter rehabilitation stays. Growth-focused companies are responding by ensuring adequate caregiver capacity, developing systems to match clients with available payer sources, and building data-driven relationships with referral partners. The shift reflects broader post-acute care trends affecting discharge planning and community-based service capacity. Providers must adjust staffing models and payer mix strategies to serve this population sustainably.

Federal Policy·47d ago

House Democrats Introduce Medicare At Home Act Adding Part B Home Care Benefit

House Democrats introduced the Medicare At Home Act, legislation that would add a home care benefit to Medicare Part B. The bill follows a Democratic policy framework released two months earlier. If enacted, the legislation would expand Medicare coverage to include home care services currently excluded from the program. The bill does not directly affect Medicaid managed care operations, though state Medicaid agencies managing dual-eligible populations and Medicare-Medicaid Plans would need to coordinate benefits if the legislation advances.

Industry·CA·47d ago

Seen Health PACE Program Reaches 280 Participants, Plans Second Site

Seen Health, a Los Angeles-based PACE provider serving Asian and Pacific Islander older adults, has enrolled more than 280 participants since opening its first San Gabriel Valley facility in January 2025. The company is expanding with a second site. PACE programs provide comprehensive medical and social services to seniors eligible for nursing home care, allowing them to remain in the community. PACE operates under capitated Medicaid and Medicare financing, with state Medicaid agencies and CMS jointly overseeing program standards and rate-setting.

Federal Policy·49d ago

Senate Bill Would Reset Home Health Base Rate, Expand CMS Fraud Authority

Sen. Susan Collins introduced legislation to reset the Medicare home health base payment rate and grant CMS additional fraud enforcement tools. The bill applies to Medicare home health, not Medicaid home and community-based services. It reflects congressional scrutiny of home health fraud while supporting payment stability. No effective date or timeline for committee action has been announced.

Legal·50d ago

DOJ Fraud Division Targets Home Health and Hospice with Data-Driven Enforcement

The Department of Justice Fraud Division identified home health and hospice as top enforcement priorities in a Thursday memorandum, signaling intensified scrutiny of these sectors. The agency plans to deploy advanced data analysis techniques to detect fraud schemes and increase staffing for healthcare fraud investigations. The directive takes effect immediately as DOJ resource allocation shifts toward these provider types. This matters for Medicaid managed care plans and state agencies because home- and community-based services, including home health and hospice, represent significant portions of LTSS spending, and heightened federal fraud enforcement will likely require enhanced provider credentialing, claims auditing, and program integrity protocols.

Industry·51d ago

Aveanna Plans Home Health and Hospice M&A After Hitting Payer Strategy Goals

Aveanna Healthcare reported achieving its preferred payer strategy goals ahead of schedule and announced plans to pursue additional acquisitions in home health and hospice, its fastest-growing segment. The company cited improved federal government affairs and payer contracting results as key drivers for expanding in this service line. Aveanna updated its home health and hospice organic growth projections from 5-7% based on these developments. The company's focus on preferred payer arrangements and acquisition activity reflects broader industry consolidation in post-acute care.

Industry·ND·52d ago

Altru Health System Closes Home Health Line in North Dakota Citing Regulatory Burdens

Altru Health System will close its home health service line effective September 1, 2026, citing regulatory burdens as the reason. The Grand Forks, North Dakota-based health system serves 230,000 residents across northeast North Dakota and northwest Minnesota with 3,100 staff. Patients who continue to qualify for home health services will need alternative providers. The closure reflects ongoing operational challenges in the home health sector that may affect Medicaid beneficiaries' access to home-based care in the region.

Federal Policy·54d ago

Collins Bill Would Reset Medicare Home Health Rates, Expand CMS Fraud Authority

Sen. Susan Collins (R-Maine) introduced legislation to restore Medicare home health payment rates to pre-cut levels and provide CMS with expanded fraud prevention and detection authority. The bill targets home health payment integrity while reversing recent years of Medicare rate reductions. The proposal would affect Medicare home health providers' reimbursement and compliance obligations, though specific effective dates and fraud-fighting mechanisms are not detailed in available reporting. Home health agencies would see financial and operational impact if the bill advances.

Managed Care·55d ago

Home Care Providers Focus on Caregiver-Client Matching to Reduce Turnover

Home care providers are emphasizing precise caregiver-client matching to address workforce retention challenges. Strong matches improve caregiver satisfaction and reduce turnover, while mismatches contribute to burnout and service disruptions. The approach targets operational stability amid ongoing labor shortages in home care. For Medicaid managed care plans and home and community-based services providers, improved matching strategies may reduce network instability and service continuity issues affecting LTSS members.

Industry·58d ago

Home-Based Care Providers Face Leadership Turnover, AI Adoption, and Federal Fraud Enforcement

The home-based care industry is experiencing simultaneous shifts in executive leadership, operational technology adoption including artificial intelligence, and heightened federal fraud enforcement activity. These changes affect provider operations across referral management, compliance infrastructure, and organizational strategy. The convergence of these forces requires providers to adapt internal processes while managing regulatory and enforcement risk. Medicaid-funded home health and personal care providers face particular exposure given their reliance on fee-for-service and managed care contracts.

Industry·58d ago

Addus HomeCare Reports Q2 Growth, Signals Continued M&A Activity

Addus HomeCare Corporation reported 6.8% year-over-year organic revenue growth in personal care services during Q2 2026, with its recent acquisition of Indiana-based HomeCourt Home Care exceeding leadership expectations due to higher-than-anticipated client volumes. The HomeCourt acquisition contributed two months of revenue to the quarter. Company leadership indicated plans to pursue additional merger and acquisition opportunities in the home care sector.

Legal·PA·60d ago

DOJ Charges 19 Defendants in $4M Medicare and Medicaid Home Health Fraud Scheme

The Department of Justice, in coordination with the U.S. Attorney's Office and Pennsylvania Attorney General, charged 19 defendants in a $4 million Medicare and Medicaid fraud scheme involving home health services. The alleged scheme included billing for services never rendered and submitting claims for unrealistic service hours. The charges were announced in early August 2026. The enforcement action signals continued federal and state scrutiny of home health billing practices, particularly phantom billing and time-based service inflation.

Legal·65d ago

DOJ Abandons Longstanding Olmstead Enforcement Guidance Affecting HCBS Programs

The Department of Justice announced last week it will no longer rely on its longstanding guidance interpreting Olmstead v. L.C., the landmark ADA case requiring states to provide community-based services to individuals with disabilities rather than institutional care. The shift represents a major change in how DOJ enforces disability rights protections that underpin state Medicaid home and community-based services programs. The policy change takes effect immediately. This matters because DOJ enforcement has historically pressured states to expand HCBS capacity and reduce institutional placements — a retreat from that enforcement posture could affect state investment decisions, HCBS waiver design, and provider networks built around community integration mandates.

Industry·66d ago

Home Infusion Demand Grows Amid Reimbursement and Site-of-Care Restrictions

Demand for home infusion services is accelerating as payers and health systems move patients to lower-cost settings and expedite hospital discharges. Providers face operational obstacles including site-of-care restrictions that limit where services can be rendered and delivered, inconsistent contracting standards across payers, and reimbursement constraints that complicate scaling these programs. The trend affects Medicaid managed care plans seeking cost savings through alternate site strategies and providers adjusting care delivery models to accommodate payer preferences for home-based treatment.

Industry·67d ago

High Interest Rates Create Buying Opportunities in Home-Based Care M&A

Higher borrowing costs have slowed merger and acquisition activity in the home-based care sector, but investors willing to enter the market now may benefit from more favorable deal terms. The slower dealmaking environment has made compliance screening a more important factor in transactions. Buyers able to absorb higher interest rates are finding opportunities as sellers face pressure to consolidate. The shift affects Medicaid managed care organizations and state agencies contracting with home health and home- and community-based services providers.

Industry·67d ago

Hospital-at-Home Programs Show Equivalent Readmission Rates for Heart Failure Patients

A study published in JAMA Network Open found that heart failure patients receiving advanced medical care at home had comparable post-discharge outcomes to those treated in traditional hospital settings, with no significant differences in readmission rates. The research supports hospital-at-home as a viable alternative care delivery model for heart failure management. The findings may inform future Medicaid coverage policies and managed care contracting decisions around alternative site-of-service arrangements. The study provides evidence on quality and safety parity between home-based and facility-based acute care for this high-cost, high-utilization condition.

Industry·67d ago

Flourish Health Raises $26M Series A for In-Home Youth Mental Health Services

Flourish Health, a youth mental health provider offering in-home visits for young people with serious, complex behavioral health needs, raised $26 million in Series A funding led by B Capital, F-Prime, and Cherryrock Capital. The round brings total funding to $46 million. The company provides home-based care through specialized workers for youth with high-acuity mental health conditions. This expansion comes as states increasingly contract with specialized behavioral health providers to serve high-need Medicaid populations, particularly children with serious emotional disturbance.

Industry·69d ago

Bayada Deploys AI Clinical Decision Support to Reduce Home Health Hospitalizations

Home-based care provider Bayada is using AI-enabled clinical decision-support tools to identify patients at elevated risk of hospitalization earlier than traditional manual chart review. The tools synthesize electronic medical record data and clinical documentation to flag risk signals for care teams, enabling preventive interventions before conditions deteriorate. The approach aims to reduce avoidable acute care use among home health patients. This development matters for Medicaid managed care organizations that contract with home health agencies and bear financial risk for preventable hospitalizations, particularly in states with LTSS carved into managed care.

Managed Care·72d ago

Survey Finds 62% of Family Caregivers View Home Care as Long-Term Solution

A 2026 report from A Place for Mom found that 62% of family caregivers view home care as a long-term or permanent solution for aging in place, suggesting families are more likely to adjust home care hours than transition to institutional settings. The finding indicates sustained demand for home and community-based services. While the brief article does not provide detailed methodology or timing, the trend reflects ongoing caregiver preferences that influence LTSS utilization patterns and Medicaid HCBS program design.

Industry·72d ago

Home Health Care News Profiles Six Home Health Companies for 2026

Home Health Care News highlights six home health companies amid a 2026 landscape shaped by a Medicare enrollment moratorium aimed at combating fraud and increased federal program integrity enforcement. The article examines how these companies are positioned to navigate regulatory constraints that industry observers say may limit provider growth. The coverage appears focused on business strategy and market positioning rather than Medicaid-specific policy developments.

Federal Policy·72d ago

House Bill Proposes EHR Implementation Grants for Home Health and Post-Acute Providers

The Connecting Health and Records Technology for Seniors (CHARTS) Act has been introduced in the U.S. House of Representatives to provide up to $500,000 grants for home health, long-term care, and post-acute care providers to implement electronic health records and improve health information sharing. The legislation aims to reduce implementation costs and administrative burden for providers serving Medicare and Medicaid beneficiaries. If passed, the grants would support interoperability efforts critical to care coordination for dual-eligible and Medicaid long-term services and supports populations. The bill is in the early legislative stage with no timeline for passage.

State Policy·72d ago

Political Dispute Over Medicaid Payment Deferrals Threatens Home Care Provider Stability

Political tensions are escalating around states' use of Medicaid payment deferrals, with home care providers caught in the crossfire. The dispute centers on whether states can delay payments to manage budget cycles, a practice that disproportionately affects home- and community-based services providers operating on thin margins. Home care advocates warn that payment timing conflicts threaten provider solvency and beneficiary access to HCBS. The controversy reflects broader partisan divisions over Medicaid financing and state flexibility in program administration.

Industry·73d ago

Choice Health at Home Plans National Expansion Amid Regulatory Uncertainty

Choice Health at Home, which serves 15,000 patients, is pursuing national expansion despite regulatory challenges including a federal enrollment moratorium and Medicaid policy changes under the One Big Beautiful Bill Act (OBBBA). CEO David Jackson outlined the company's westward growth strategy for 2026. The expansion comes as home-based care providers navigate heightened federal scrutiny, enrollment restrictions, and uncertain Medicaid reimbursement. The company's plans signal continued private investment in home health despite regulatory headwinds affecting the sector.

Federal Policy·73d ago

CMS Clarifies Home Health Acceptance-to-Service Requirements in Survey Guidance

CMS issued updated survey guidance on July 16, 2026, clarifying home health agencies' obligations under the acceptance-to-service standard in the Home Health Agency Conditions of Participation. The standard, which took effect in January 2025, requires agencies to develop, implement, and maintain policies governing patient acceptance. The guidance provides surveyors and agencies with clearer expectations for compliance. For Medicaid managed care organizations contracting with home health providers, this guidance affects network adequacy assessments and provider compliance monitoring.

Federal Policy·CA·74d ago

HHS Defers $1 Billion in Federal Medicaid Payments to Two States

HHS and CMS announced Tuesday they deferred over $1 billion in federal Medicaid payments to two states, including $867.5 million to California, citing high-risk claims including home-based services. The deferrals represent a federal payment hold while CMS reviews claims for potential fraud, waste, or abuse. The action takes effect immediately. This is significant because payment deferrals can strain state budgets and delay provider payments, potentially disrupting network adequacy and access to home and community-based services that many MCOs coordinate or manage under managed long-term services and supports contracts.

Industry·79d ago

Home Health Providers Pursue Joint Ventures During CMS Enrollment Moratorium

CMS imposed a six-month moratorium on new Medicare home health enrollments, limiting traditional expansion paths for providers. Industry operators report that growth-minded agencies are pursuing organic growth, mergers and acquisitions, and joint ventures to scale operations despite enrollment restrictions. The moratorium affects provider capacity to enter new markets through new enrollments but does not prevent changes of ownership or partnerships with existing enrolled agencies. Providers are adapting expansion strategies to work within the temporary enrollment freeze.

Managed Care·80d ago

Home Health Providers Reject 63% of Referrals Due to Workforce Shortages

A Homecare Homebase report found that 63.3% of home health providers are turning down referrals, with referral conversion rates declining 13%. Providers cite staffing shortages as the primary reason for rejections. Documentation burden and scheduling friction are identified as key drivers of workforce turnover in home-based care settings. The findings indicate growing constraints on home health capacity despite rising demand for services.

Managed Care·82d ago

Home-Based Care Providers Address Social Determinants Without Direct Payment

Home-based care providers are addressing social determinants of health despite lacking direct financial incentives. Providers report that removing barriers like food insecurity, housing instability, and transportation gaps improves care outcomes and enables frontline workers to deliver contracted services more effectively. The activity reflects growing provider investment in upstream interventions that affect utilization, quality metrics, and total cost of care. Medicaid managed care organizations increasingly rely on home-based providers for complex populations where social determinants directly affect clinical outcomes and plan performance.

Industry·83d ago

Home Health Care News Profiles Six Home Care Companies for 2026

Home Health Care News published a profile of six home care companies navigating operational challenges in 2026. The article cites Medicaid reimbursement pressures, proposed 80-hour work requirements, fraud enforcement, technology adoption, and mergers and acquisitions as key factors shaping the sector. The publication does not report specific policy changes or enforcement actions, but rather frames the operating environment for home care providers. No effective dates or comment periods are provided because this is an industry profile rather than a policy document.

Industry·85d ago

Dementia Costs Projected at $818 Billion in 2026, Threatening Home Health Workforce

Dementia and Alzheimer's disease are projected to cost the United States $818 billion in 2026, with families and individuals bearing more than 80% of the economic burden according to a study in Alzheimer's & Dementia. Flournoy Health Systems CEO warns this growing cost pressure could further strain the home health workforce. The projections come as managed care organizations face increasing demand for long-term services and supports, particularly home and community-based services for members with cognitive impairment. The workforce impact threatens network adequacy for LTSS benefits.

Industry·87d ago

UnitedHealth HouseCalls Program Reduces Hospitalizations by 5%, ER Visits by 4%

UnitedHealth Group reported that its HouseCalls in-home health program resulted in up to 5% fewer inpatient stays and 4% fewer emergency room visits for older adults with chronic conditions like diabetes and hypertension in the year following their visit. The findings come from an external analysis of initial program results announced Tuesday. The program targets Medicare Advantage and dual-eligible beneficiaries with in-home preventive visits. Results suggest potential value for managed care organizations exploring home-based interventions to reduce acute care utilization among high-risk populations.

Legal·NY·89d ago

PPL Reaches $162M Settlement Over New York CDPAP Payroll Violations

A federal judge preliminarily approved a $162 million class action settlement with approximately 200,000 home care workers alleging payroll and benefits violations following New York's transition of its Medicaid-funded Consumer Directed Personal Assistance Program (CDPAP) to a single fiscal intermediary, Public Partnerships LLC (PPL). The settlement addresses claims arising from the state's consolidation of CDPAP fiscal intermediary services. The approval comes weeks after DOJ involvement in related matters. Final approval is pending.

Managed Care·94d ago

Hurricane Flooding Extends Home Health Treatment Times by Two Weeks

New research finds that hurricanes and related flooding cause significant disruptions to home health services, adding nearly two weeks to treatment times and reducing rates of successful discharge to the community. The decentralized structure of home health care makes both providers and payers particularly vulnerable to extreme weather events. The findings highlight operational and quality risks for managed care organizations that contract for home-based services, especially those serving dual-eligible populations and members with complex care needs who rely on consistent in-home support.

Managed Care·97d ago

Home-Based Care Payment Models Focus on Value, Risk, and Coordination

Industry leaders at the PAYER Summit identified three payment trends reshaping home-based care delivery: value-based payment arrangements replacing fee-for-service, increased provider risk-sharing with managed care organizations, and stronger payment incentives for care coordination across post-acute settings. These shifts affect how MCOs structure home health and home-based primary care contracts. The trends reflect broader movement toward outcomes-based reimbursement in Medicaid managed long-term services and supports. Payer executives and providers agreed these payment changes will determine which home-based care organizations remain viable partners for health plans.

Federal Policy·101d ago

CMS Projects Home Health Spending Growth to Slow to 7.9% in 2026

CMS projects national home health care spending will grow 7.9% in 2026, down from 10.3% in 2025, according to a Health Affairs report on national health expenditure projections. The deceleration reflects moderating post-pandemic utilization trends while still indicating strong growth in the home health sector. The projections cover total national home health spending across all payers, including Medicare, Medicaid, and commercial insurance. For Medicaid managed care organizations with home health benefit responsibility or LTSS carve-ins, the projections signal continued upward pressure on capitated rates and medical expense ratios in the home health category.

Industry·103d ago

CareChoice CEO Scales Back Services Due to Limited Hospital Referrals

Arsen Ustayev, founder and CEO of CareChoice, is adjusting his company's service offerings and geographic footprint based on hospital referral patterns and varying state Medicaid policies. The executive, who previously founded adult day care provider SarahCare in Pennsylvania, has reduced certain services where hospital system referrals have not materialized as expected. His strategy reflects the critical role that hospital discharge planning and referral networks play in home health and post-acute care success, particularly in Medicaid-focused markets where state policy differences create operational complexity.

Industry·106d ago

Freedom Senior Services Names New CEO Following Gemspring Capital Acquisition

Freedom Senior Services has appointed Dr. Brian Holzer as CEO following the company's acquisition by private equity firm Gemspring Capital. Holzer, a home-based care veteran, stated he plans to pursue aggressive mergers and acquisitions while expanding the company's service lines and client demographics. The leadership change follows the ownership transition to Gemspring Capital. This move signals continued consolidation in the home health sector, which increasingly serves Medicaid managed long-term services and supports (LTSS) beneficiaries.

Legal·NY·109d ago

DOJ Sues New York DOH and PPL Over CDPAP Fiscal Intermediary Fraud Allegations

The U.S. Department of Justice filed a lawsuit Tuesday against the New York Department of Health and Public Partnerships LLC (PPL), alleging fraud in the state's transition of the Consumer Directed Personal Assistance Program (CDPAP) to a single fiscal intermediary. DOJ claims the arrangement was designed to extract millions from New York's Medicaid program through improper payments. The lawsuit targets both the state agency that selected PPL and the fiscal intermediary itself. CDPAP allows Medicaid beneficiaries to direct their own long-term care services, with fiscal intermediaries handling payroll and administrative functions.

Managed Care·111d ago

Home-Based Care Providers Limit Medicare Advantage, Medicaid Admissions Amid Payment and Administrative Pressures

A recent survey of home-based care providers reveals that Medicare Advantage and Medicaid payment rates, administrative burden, prior authorization delays, and denials are driving some providers to restrict admissions for certain payers. Providers cite these factors as top operational concerns. The trend affects access to home-based care for Medicaid managed care enrollees and Medicare Advantage beneficiaries. This reflects broader tensions between managed care plans and home health providers over reimbursement adequacy and administrative requirements.

Federal Policy·114d ago

CMS Announces Strict Budget Neutrality Requirement for Section 1115 Waivers

CMS announced Thursday it will implement a strict budget neutrality requirement for Medicaid Section 1115 demonstration waivers. The agency is providing states early notice of its intent to apply new budget neutrality standards to demonstrations. Section 1115 waivers allow states to test innovative approaches in Medicaid, including delivery system reforms and coverage expansions that often involve managed care organizations. The new standards will affect how states structure and finance waiver programs going forward.

Legal·OH·114d ago

Ohio Medicaid Suspends Payments to 49 Home Health Providers Over Billing Patterns

The Ohio Department of Medicaid suspended payments to 49 home health providers based on suspicious billing patterns, marking an early state-level response to CMS guidance on heightened program integrity enforcement. The suspensions target at-home care providers and reflect a broader shift in Medicaid oversight from traditional post-payment review to proactive payment holds. The timing and scope of the action align with recent CMS directives emphasizing aggressive fraud prevention in home and community-based services. This signals that states are accelerating enforcement activity in the LTSS and home health sectors, where billing irregularities have drawn increased federal attention.

Legal·OH·120d ago

Ohio Suspends 49 Home Health Providers for Billing Irregularities

The Ohio Department of Medicaid suspended payments to 49 home health providers on Thursday following identification of suspicious billing patterns. The action aligns with broader federal enforcement efforts targeting Medicaid-funded home-based care. The suspensions appear connected to a gubernatorial executive order, though implementation details were not specified in the announcement. Managed care organizations contracting with affected providers should review care continuity protocols and confirm any required network substitutions.

Federal Policy·124d ago

CMS Issues Interim Final Rule Imposing 80-Hour Monthly Work Requirement for Adult Medicaid Beneficiaries

CMS released an interim final rule Monday requiring certain adult Medicaid beneficiaries to meet an 80-hour monthly work requirement. The rule takes effect as an interim final rule, meaning it is immediately enforceable while CMS accepts public comments. Experts warn the requirement could reduce health coverage for home care workers, potentially disrupting LTSS workforce stability and service continuity for Medicaid managed care beneficiaries who rely on home-based services. The rule affects adult beneficiaries in non-expansion populations, though specific exemptions and state implementation timelines remain unclear from this brief announcement.

Industry·125d ago

Home-Based Care Providers Diversify Payer Mix Amid Reimbursement Pressure

Home-based care providers are restructuring their business models in response to sustained reimbursement cuts and policy changes across payers. Providers report cumulative financial strain from incremental rate reductions and inconsistent payment structures. In response, agencies are diversifying their payer portfolios and forming local partnerships to maintain financial viability. These strategic shifts are occurring now as providers adapt to what industry leaders describe as accumulating incremental cuts rather than single policy changes.

Federal Policy·125d ago

DOL Rescinds 2024 Overtime Rule, Reverts to 2019 Salary Thresholds

The U.S. Department of Labor formally rescinded the 2024 overtime rule and returned to the 2019 salary threshold framework. The 2024 rule would have expanded overtime eligibility for home care workers, but courts vacated it after the first threshold increase took effect. The rescission provides immediate relief to home health and home care providers who faced increased labor costs under the 2024 standards. Providers operating under Medicaid managed care contracts can now plan staffing and budgets using the lower 2019 thresholds.

Federal Policy·125d ago

Democratic Senators Propose Medicare Home Care Benefit and Medicaid HCBS Expansion

A group of Democratic senators released a policy framework Wednesday to create a new Medicare home care benefit and expand Medicaid home- and community-based services. The proposal represents a significant shift in federal long-term care policy, potentially affecting how both Medicare and Medicaid fund home-based care. Details on implementation timelines, eligibility criteria, and financing mechanisms have not yet been specified. If enacted, the framework could reshape payment structures and access requirements for home health and HCBS providers serving dual-eligible and Medicaid-only populations.

Federal Policy·125d ago

Rep. Van Duyne Introduces Bill to Strengthen Medicare Home Health and Hospice Oversight

Rep. Beth Van Duyne (R-Texas) introduced the Protecting Seniors and Stopping Fraudsters Act on Wednesday to increase Medicare oversight of home health and hospice services. The bill aims to crack down on fraudulent providers and enhance beneficiary protections in these sectors. The National Alliance for Care at Home has expressed support for the legislation. While the bill targets Medicare, Medicaid managed care organizations that contract with home health and hospice providers should monitor this legislation, as federal fraud enforcement standards often inform state oversight approaches and MCO network adequacy requirements.

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