Medicaid Monitor
Policy Intelligence
Medicaid Monitor
Policy Intelligence
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Home Health Care News

53 stories

Industry·13h 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.

Industry·13h 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.

Federal Policy·1d 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·1d 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.

Legal·4d 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.

Federal Policy·5d 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.

Industry·5d 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·8d 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.

Managed Care·9d 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.

Federal Policy·12d 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.

Industry·12d 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.

Legal·PA·14d 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.

Industry·15d 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·19d 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·20d 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·21d 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·21d 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·23d 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·23d 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.

State Policy·26d 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.

Federal Policy·26d 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.

Industry·27d 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.

Managed Care·29d 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.

Federal Policy·CA·29d 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·30d 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·34d 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.

Managed Care·34d 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.

Industry·36d 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·36d 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·37d 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·40d 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·42d 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·43d 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·49d 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·51d 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·55d 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·57d 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·61d 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·63d 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·65d 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·68d 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·68d 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·75d 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.

Legal·OH·75d ago

Ohio Suspends Payments to 49 Home Health Providers Over Fraud Concerns

The Ohio Department of Medicaid suspended payments to 49 home health providers effective Thursday following identification of suspicious billing patterns. The action is part of a broader federal crackdown on Medicaid-funded home-based care fraud. The suspensions are immediate and providers remain under investigation. This enforcement wave reflects heightened scrutiny of home health billing practices across state Medicaid programs, with potential implications for network adequacy and managed care organization oversight of home health subcontractors.

Federal Policy·78d 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·79d 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·79d 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·79d 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·79d 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.

Federal Policy·79d ago

House Bill Would Tighten Medicare Oversight of Home Health and Hospice Providers

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 protections for seniors receiving home-based care. The National Alliance for Care at Home publicly supports the legislation. While focused on Medicare, the bill's fraud prevention framework could influence Medicaid managed care organizations that contract with home health and hospice providers for dual-eligible members and long-term services and supports.

Federal Policy·79d ago

Senate Democrats 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. The framework aims to improve access to home-based care and stabilize payment structures for providers. Timing for legislative action remains unclear, but the proposal signals renewed congressional interest in expanding home care coverage under both Medicare and Medicaid.

Federal Policy·79d ago

DOL Rescinds 2024 Overtime Rule, Reverts to 2019 Salary Thresholds

The U.S. Department of Labor formally rescinded its 2024 overtime rule and returned to the 2019 salary threshold framework for overtime eligibility. The 2024 rule had partially taken effect before courts vacated it following the first salary threshold increase. The rescission provides immediate relief to home health and personal care providers who faced significant compliance and cost pressures under the expanded overtime requirements. The reversion to 2019 thresholds stabilizes wage and hour obligations for home care agencies, many of which serve Medicaid beneficiaries.

Managed Care·79d ago

Home-Based Care Providers Diversify Payer Mix to Counter Reimbursement Cuts

Home-based care providers are responding to cumulative reimbursement cuts by diversifying payer portfolios and building local partnerships to maintain financial viability. Industry leaders report that incremental payment reductions and policy shifts across government and commercial payers are forcing strategic changes in contracting approaches. Providers are actively expanding relationships beyond traditional Medicare fee-for-service to include managed care contracts and alternative payment arrangements. The shift reflects growing pressure on home health economics that directly affects network adequacy and access for Medicaid managed care enrollees.

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