Home health care providers are facing reimbursement challenges on many fronts, necessitating layoffs and other difficult strategic decisions.
In light of the upcoming 2026 Home Health Final Payment Rule, Medicaid funding cuts from the One Big Beautiful Bill, and more, companies like Healthview Home Health and Bryan Skilled Home Care are ramping up advocacy efforts and focusing on their strengths to navigate choppy reimbursement waters.
As a company that provides care to Medicaid managed long-term care and NHTD/Traumatic Brain Injury Waiver participants, Brian Skilled Home Care is preparing to operate in an environment with less funding within the system.
“That means it's going to be harder to negotiate,” Brian Madden, CEO of Brian Skilled Home Care, told Healthcare News' FUTURE conference. “What if negotiation is a little difficult? Over the years, we really learn how to emphasize what we're good at.”
Based in New York, Bryan Skilled Home Care is a personal care and skilled nursing provider licensed by the New York State Department of Health. The company has operations on Long Island and Queens.
For Bryan Skilled Home Care, highlighting what the company does best means leaning into its best metrics.
“We never miss a visit,” Madden said. “It's very simple. It leads to increased patient satisfaction and (reduced) complaints to payers. Be clear about what you're doing well.”
Healthview CEO Steven Gonzalez recognizes the risk of a 6.4% cut in home health costs. That's why the company took the time to advocate on behalf of the industry on Capitol Hill in August.
“It's been a pretty successful effort for home health, hospice and telemedicine,” Gonzalez said during the discussion. “We're gearing up for a 6% cut, but if that's what we've seen over the past few years, it's probably more like 9%. We've already started working on operational efficiencies to get to that 6%. So if the stabilization document is approved, next year's rate cuts should be frozen. That would be good for us.”
Founded in 1967, HealthView is a Cerritos, California-based provider of home care services including independent duty nursing, skilled nursing, personal and companionship, and other home services.
Source: Brian Madden, Steven Gonzalez, Hilary Loeffler
To achieve operational efficiency, HealthView has embraced technology. However, the company continues to feel the impact of the volatile reimbursement environment.
“While we can leverage technology to increase our workforce by 10 times, the reality is that we had to lay off employees, just like many other home health (companies) have had to do,” Gonzalez said. “That's what we talked about last week with Congress and with the California Senate.”
alternative solution
Hilary Loeffler, vice president of policy and regulation for the National Home Care Alliance, said her organization is calling on the administration and Congress to rethink the way it cuts home health benefits.
“I don’t think they calculated the reductions properly and followed the intent of the statute,” she said during the discussion. “If this comes together as proposed, we will have to move to Plan B, hopefully relying on our allies in Congress who just recently introduced the Home Health Care Stabilization Act of 2025.”
The Home Health Care Stability Act of 2025 was introduced in September by Rep. Kevin Hahn (R-Okla.) and Rep. Terry Sewell (D-Ala.). The bill would suspend reimbursement rate reductions for the next two years.
Loeffler explained that the bill would also give the industry time to work on comprehensive reforms to permanently address rate cuts. He said he expects CMS will likely finalize a less stringent version of the proposed rule, but said the milder cuts would not sufficiently improve the operating environment for home health care.
“I think they're probably going to pull back, but to me success isn't just cutting it in half or going away,” Loeffler said. “They really need to rethink their methodology. Right now, their proposed temporary adjustment to 5% is to start recouping $5 billion from the industry, and unless they change their methodology and how they calculate the savings, which we think they're making a mistake, we're just going to continue to reduce rates by 5% for another seven, eight, nine years, which is completely unsustainable for the industry.”
Loeffler encourages home health care providers to keep fighting.
“A squeaky wheel gets oily, and I think when it comes to the health of our families, we need to make our voices heard louder and more often,” she said. “I encourage everyone here to reach out to their congressmen, senators, and representatives. Call them, email them, write them letters. If you're ever in Washington, D.C., please schedule a meeting with your representatives.”
Brian Skilled Home Care also helped draft minimum reimbursement legislation for Medicaid managed care, which Madden said would be “very important” to the organization. Madden is also heavily involved with the New York State Healthcare Providers Association.
“We're bringing in state senators and congressmen to educate and raise awareness about what's going on in the industry,” he said. “I think people often forget how important home care is to the proper functioning of society.”
