The Reimbursement Squeeze: A Multi-Front Challenge

Home-based care providers are confronting a convergence of financial pressures, forcing difficult decisions including staff reductions. The impending 2026 Medicare home health final payment rule, coupled with proposed Medicaid cuts stemming from the “One Big Beautiful Bill”, are creating a volatile reimbursement environment.

Bryan Skilled Home Care, serving Medicaid-managed long-term care and NHTD/TBI waiver participants in New York’s Long Island and Queens, is preparing for a future with diminished resources. “That’s gonna mean harder negotiations,” explains Bryan Madden, CEO of Bryan Skilled Home Care. “What do we do when it’s a little bit harder to negotiate? Over the course of years, we really learn to accentuate what we do well.”

For Bryan Skilled Home Care, that “something” is consistently delivering scheduled visits. “We don’t miss visits,” Madden emphasizes. “It’s pretty simple. That then leads to better patient satisfaction and fewer complaints to the payer. Articulate what you do well.” This commitment to reliability is a key differentiator in a market increasingly focused on value-based care.

Advocacy and Operational Efficiency: A Two-Pronged Approach

Healthview Home Health, a California-based provider founded in 1967, is also actively engaged in shaping the policy landscape. Steven Gonzalez, Healthview’s CEO, highlights the company’s recent advocacy efforts on Capitol Hill in August. “It was a pretty successful outing for home health, hospice and telemedicine,” Gonzalez stated. “We’re preparing for the 6% decrease, it’s kind of more like 9% if it actually happens over the last few years.”

Healthview is proactively implementing operational efficiencies to mitigate the impact of the anticipated cuts. The company is leveraging technology to amplify employee capabilities, though Gonzalez acknowledges the difficult reality of recent layoffs. “You can 10x an employee by amplifying them with technology, but the reality is, we did have to lay people off, just like a lot of other home health companies had to do,” he said. “That was something we did talk with Congress about last week, and our Senate in California.”

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Legislative Efforts to Stabilize Home Health Funding

Industry organizations are also pushing for legislative solutions. Hillary Loeffler, vice president of policy and regulatory affairs at the National Alliance for Care at Home (the Alliance), is advocating for a reevaluation of the methodology used to calculate home health payment cuts. “We don’t believe that they’re calculating the reductions appropriately and following the intent of the statute,” Loeffler explained.

The Home Health Stabilization Act of 2025, introduced by Representatives Kevin Hern (R-Okla.) and Terri Sewell (D-Ala.), offers a potential reprieve by pausing reimbursement rate cuts for two years. Loeffler believes this pause would provide crucial time for comprehensive reform. However, she cautions that even a softened cut is unsustainable in the long term. “They really need to revisit the methodology,” she asserts. “Right now, the temporary adjustment that they proposed to 5% that’s to start recouping $5 billion from the industry, and unless they change their methodology and how they’re calculating these cuts, which we think they’re making mistakes on, we’re just facing seven, eight, nine more years of 5% cuts to our rates, which is completely not sustainable for the industry.”

Loeffler urges providers to actively engage with their elected officials. “The squeaky wheel tends to get the grease, and I think with home health, we need to make our voices heard more loudly and more frequently,” she said. “I encourage everyone here to reach out to their members of Congress, their senators, their representatives. Call them, write emails, and write letters. If you’re ever in DC, schedule a meeting with your representative.”

Bryan Skilled Home Care is also proactively drafting legislation for a minimum reimbursement rate for Medicaid managed care, recognizing its critical importance to the organization’s financial stability. Madden emphasizes the often-overlooked value of home care: “I think it’s easy for people to forget how important home care is to a normally functioning society.”

What strategies are home health agencies employing to maintain quality of care amidst these financial constraints? And how can policymakers better understand the vital role home health plays in the broader healthcare ecosystem?

Frequently Asked Questions About Home Health Reimbursement

• What is the Home Health Stabilization Act of 2025?

  The Home Health Stabilization Act of 2025 is legislation proposed by Representatives Kevin Hern and Terri Sewell that would temporarily pause Medicare reimbursement rate cuts for home health agencies for two years, providing time for comprehensive reform.

• How will the proposed Medicare cuts impact home health agencies?

  The proposed 6.4% Medicare cuts, potentially reaching 9% over time, are expected to significantly strain home health agency finances, potentially leading to reduced services and staffing shortages.

• What steps are home health providers taking to address reimbursement challenges?

  Home health providers are employing a two-pronged approach: actively advocating for policy changes and implementing operational efficiencies, including leveraging technology and focusing on delivering high-quality, reliable care.

• What role does the National Alliance for Care at Home play in advocating for the industry?

  The National Alliance for Care at Home (the Alliance) is actively pushing for a reevaluation of the methodology used to calculate home health payment cuts and supports legislative efforts like the Home Health Stabilization Act.

• Why is consistent visit completion a key metric for home health agencies?

  Consistently completing scheduled visits demonstrates reliability, leading to improved patient satisfaction and fewer complaints to payers, ultimately strengthening an agency’s financial position.