This article is part of the HHCN+ membership
The 2026 “terrifying” home hygiene proposal payment rules, and Medicaid events across the state and nationwide, were two of the hottest topics at the 2025 National Alliance for Home Financial Summit last month.
Despite these updates and challenges, providers are not only adapting preemptively, they are fighting back.
“This is a false policy,” Dr. Steven Landers, CEO of the National Alliance for Home (The Alliance), said at the meeting. “It's dangerous. If it's implemented it would hurt people. We're not going to implement it the way it's proposed.”
Landers' comments were a good sum of general attitudes among insiders in the home care industry who attended the meeting.
At the meeting, many providers and experts are shedding light on the impact of proposed payment rules and Medicaid cuts on business and access to care. Listening directly from the industry left me with two important takeaways.
– Home health providers are still handling the fallout from the payment rules proposed in 2026, but are united in counterattack efforts.
– Providers are also preparing to navigate the Medicaid landscape in light of large cuts.
This week's exclusive member-only HHCN+ update will delve deeper into the face of being with me after the event is over.
Providers are still caught up from the proposed rules
In the weeks since the Centers for Medicare & Medicaid Services (CMS) removed its 2026 home health payment rules proposal, providers have become more and more open to pushback on how they will affect their business if they pass without changes.
Landers' keynote speech on the second day of the conference, and the accompanying panel discussion, shows that the issue remains the best for providers and industry advocates.
Ken Albert, CEO of Andwell Health Partners, discussed last year how his company must cut its care services. The move has had a negative impact on the rural communities run by the company.
“We cut our services to 58 communities, and all rural areas. There were literally no other providers picking up these areas,” he said during the panel. “I think it's going to create an access issue, but frankly, healthcare is a desert of home hygiene.”
In the past, we have reported on how rural communities face obstacles that restrict access to care, particularly compared to their counterparts in urban communities. Dr. Jennifer Schneider, CEO and co-founder of Homeward, explained some of these challenges when we spoke a few years ago.
“When you think about infrastructure, not only do doctors live there, but there are far fewer broadband connectivity and far fewer public transport, so there are few roads and often not worse situations than urban areas,” she said. “It really makes it difficult to get personal care.”
While homes and other businesses within this space are working to serve rural communities, as Albert correctly pointed out, this becomes even more difficult for providers when they cut back on refunds.
“We have a professional staff member who is very dedicated to doing this job,” Albert said. “But the refunds are not consistent, so it's a policy that has failed at this point, and that's what we have to say.”
We expect that providers will not be the only company to close or limit services in certain markets as they will have to navigate a volatile refund environment.
However, this does not mean that providers passively accept these outcomes without a fight.
In my opinion, providers are stepping up left and right. Bayada Home Health Care, for example, describes the company's advocacy efforts as “go-go-go.”
“There's no stopping, there's no advocacy. Consistency is really important,” said David Totaro, Chief Executive Officer at Bayada, in an episode of HHCN's Disrupt Podcast. “One of the things we've learned over the past six to nine months is that our role as providers is to turn our discussion of costs and cuts into a narrative of why or how these reductions affect the lives of members of our lawmakers.”
I also had the opportunity to interview Jim Melancon, Senior Vice President of the Government of Aveanna Healthcare (NASDAQ: AVAH) at an alliance event. He showed us how the company partners with state trade associations and alliances. Additionally, the company is stepping up its grassroots initiative.
“We're very active in that advocacy and really elevates our grassroots advocacy efforts,” Melancon said. “Internally, we hired a director. It's her responsibility to help us. It's our internal platform that we use in grassroots efforts. We've really stepped up in the last few years.”
At the meeting, Alliance's vice president of policy and regulation, Hillary Loeffler encouraged providers to dial their current advocacy efforts.
“What everyone needs here is to write to the CMS, comment on the proposed rules and explain how this will affect your provider, patients, families and caregivers. Please contact members of your district council,” she said. “Please ask them to meet. Write them a letter to the CMS, call them, ask them to write a letter to the CMS, and oppose this bill.”
Loeffler's proposal has extra weight as he is a former senior adviser to the Legislative Bureau of CMS. It will be interesting to see how CMS responds to protests from the industry in the coming months. In the fall, you may see the final version of the 2026 Home Health Payment Rules.
Other big cuts
Medicare isn't the only place where providers are losing sleep at this time. Another big cut affecting the industry is over $900 billion in Medicaid cuts brought about by “One Big Beautiful Bill” (OBBB).
It should be pointed out that Medicaid homes and community-based services are not directly related to the law. However, this magnitude reduction can have a negative impact.
“There's nothing specifically cutting back on home and community-based services, but that said there will be changes in these funding to the state government and the state funding formula will change dramatically depending on which state you are in,” Landers said. “The state budget will be challenged.”
The land called Medicaid the “lifeline” of individuals who needed to care for them at home. According to KFF, approximately 4.5 million people generally receive home care services through Medicaid annually.
Landers hopes that these services will continue to receive support from policymakers.
“Home and community-based services are considered optional from a state implementation perspective and may be squeezed out,” he said. “We're very worried because they can create waitlists and cut fees.”
In the past, I've covered my waiting list. Overall, these lists have around 700,000 individuals on these lists, according to KFF data analysis.
With all this in mind, Aveanna, a Medicaid-led company, is making sure to be proactive.
“We're sure we're actively working on the eligibility registration questions that come up, and they'll be different between extended and non-expanded states under the bill,” Melancon said. “As many people on Medicaid often don't know that they use Medicaid, they can be proactive in ensuring that eligibility continues for their families.”
Recently, Houseworks CEO Mike Trigilio explained how its own “payer hub” platform helps the company operate in various states.
It will be interesting to see the innovative and operational strategies that Medicaid-centric home care providers implement to survive in this environment. Technology-focused providers predict that they will step into their peers. In an industry where personnel is a very important concern, efficiency is the name of the game. Without looking at new technologies such as remote patient monitoring or HouseWorks payer hubs, home care providers may struggle to overcome future challenges.
Landers believes this could be a time when tech partners in the industry can step in and help them deal with potential points of birth.
“Maybe some of our tech entrepreneurs can play a role in supporting some of these eligibility assessments and ensuring that our workforce gets the benefits they need,” he said.
