The proposed sweep rate reduction is poised to dramatically change the home health industry, leading leaders are finding ways to protect quality of care and access.
Through an improved virtual case management model that maintains staff of home health workers ready to practice at the top of the license, or by linking workers to “why” we can help providers who increase efficiency in the face of the proposed 2026 home health rate reduction. Still, opposing the proposed 2026 Medicare home health rate reduction is important to ensure providers maintain a strong workforce.
“This is a false policy,” Dr. Steven Landers, CEO of the National Alliance for Home (The Alliance), said at the 2025 National Alliance for Home Financial Summit. “It's dangerous. It's going to hurt people.”
The Centers for Medicare and Medicaid Services are budget-neutral and are looking to modernize their home health payment system, but the reduction rates for home health care “doesn't make sense,” Landers said.
“For some reason, in 2019… the Home Health Payment System is a $17.8 billion program, and this year it will be a $15 billion program, which will be a much less valuable dollar than 2019,” Landers said. “There's been a delay in the issues of care, agency closures and rural access. That makes no sense.”
While home hygiene is “mistakes” and access to services is declining, there are cases of potential fraud in parts of the United States, Landers said. He suggested that CMS assume these “obvious inefficiencies” while supporting legitimate providers.
According to Hillary Loeffler, Vice President of Policy and Regulatory Affairs for the Alliance, the CMS' overpayment capacity unique to the home healthcare industry is its ability to collect overpayments in a given year. Loeffler said the restructuring totaled $5.3 billion from 2020 to 2024. CMS began the recovery process in 2025, representing an additional 5% cut in addition to a 4% rate adjustment.
“That's a critical point for our industry,” Loffler said. “The total baseline spending for home health programs is about $15 billion that year. Frankly, it's astronomical to owe $5 billion overpayments to CMS. We have serious problems with that methodology and we hope they can see the light in this.”
Workforce Strategy
In the face of such cost pressures, providers need to focus on efficiency.
Retention and increasing staff productivity are key strategies to do so, allowing workers to practice at the top of their licence. According to Trisha Crissman, the company's CEO, it creates a strong culture and reminds staff that it's a priority for common spirit health at home, as they chose to work in their field.
“Perhaps when it comes to clinicians in the workforce in this field, the number one focus for our organization is the need and urgency to continue to help them lead to 'why', especially as patients come to us who are much more keen than before,” Chrisman said.
Based in Milford, Ohio, Commonspirit Health at Home offers specialized home care, home infusion, hospice and medical transport services from 83 locations in 13 states. The company is the home care division of Health System Common Spirit Health.
To connect workers to “why,” Crissman said Commonspirit has updated its virtual case management model. The company predicts that Crissman could add 2,200 care for senior staff and home care, which he said was “important.” The organization is also trying to ensure that the proportion of subspecialties is sound.
Creating a positive environment also encourages workers to participate, Crissman said.
Crissman said the company has achieved its lowest turnover rate in a decade, but she is still “tensty.”
“I'm nervous, but when my clinician, an employee, realizes that perhaps all the bells and whistles aren't stacked on technology and how they have their jobs to make their lives easier because they can't afford it,” Crissman said. “So I need to understand that I can afford it. That means I have to ask how deeper questions, rather than improving efficiency and productivity with staff I already have.”
According to Landers, several potential regulatory changes could improve the current state of the workforce. The Trump administration's deregulation agenda includes proposed changes to the Fair Labor Standards Act (FLSA) and the potential repeal of the 80/20 regulations — could help plague the workforce in home health care facilities.
“Deregulation is a potential way to support our creativity and our ability to innovate and innovate our reimbursement policies,” Landers said. “Refund policies are labor policies. It's purchasing power that providers must be able to put those angels at the forefront.”
