This article is part of the HHCN+ membership
On Monday, we moderated the HHCN+ Talks episode. This is an exclusive opportunity for HHCN+ members to speak directly in real time with leading experts. The topic was about the policy and regulatory landscape affecting the home care industry under the second Trump administration.
Needless to say, this was a timely discussion given the way the week unfolded. I'm writing this, as the news is broken that the House has passed a massive tax and spending bill that includes a massive Medicaid cut that concerns health care providers. And the passage of the bill comes this week shortly after other major developments. The Talks debate occurred hours before CMS announced its Medicare payment proposal for home health care in 2026. During the talk discussion, Dr. Steven Landers, CEO of the National Alliance for Home At Home, said the rules provide some indication of the administration's approach to “behavioral adjustment” associated with a patient-driven grouping model.
“Of course, we'll always see proposals for Medicare Home Health Payment Systems for 2026 (we're looking for) CMS under the Trump administration will actively proceed with this cycle of behavioral adjustments that lie in the head of the home health system, or adjustments for them?”
After the proposed rule is removed, Lander will tell HHCN that this represents the biggest cut ever. For moderation – at least so far. Landers noted that some of the work on the proposed rules was likely done by previous administrations before Biden resigned.
HHCN will continue to cover the proposed payment reduction scope. This includes recent stories on insights from many industry leaders, including Landers' additional comments.
Despite the dangers, industry stakeholders have shown cautionary optimism. I am largely hopeful, but moderated and replied, to Landers and his co-panelist, Executive Home Care brand leader Jeanette Weinz, and David Jackson, CEO of Choice Health At Home, how I felt about the home care industry on Monday compared to how I felt in February.
And this week brought in some welcoming policy news in the home care industry.
This week's exclusive member-only HHCN+ update will feature the latest episodes of HHCN+ talk, including the possibility of abolishing the 80/20 rule, covering increased audits and investigations and future prevention business strategies. We provide analysis and key points including:
– The impact of the Trump administration's professional business and anti-combust, waste and abuse approach on home healthcare
– Action providers can take to make your business successful and create changes
Benefits of professional business
For all refunds and regulatory uncertainties, home-based care providers can also benefit from the policies promoted by Trump.
A recommendation from DOL this week is to revive dating exemptions for home care. Regaining the exemption will give the authorities the ability to expand their dating services without paying for unsustainable overtime costs when they return to situations that existed before 2013.
“Seniors want familiar, reliable caregivers, not revolving doors. When caregivers open the door to caregivers, they open their lives to them,” Bob Ross, managing partner at Cypress Home Care Solutions, said in a LinkedIn post. “Even so, agents were forced into multiple caregivers and staff cases due to the burden of overtime. This proposed rule marks a turning point. It's not a victory for agents. It's a victory for older people and their families who deserve continuity, stability, and safe and affordable care.”
Home care providers are also hoping to win the priorities of other policy. I previously reported that the Trump administration could reconsider the 80/20 rule requiring 80% of the Medicaid dollar to be spent on workers' compensation. But the conversation was the first time I'd heard such confidence that the days of the rules were undoubtedly counted.
Landers said he cannot pinpoint exactly when the rules will be repealed, but he expressed confidence that it will take some time during this administration.
The 80/20 rule is “not sustainable at all,” Wines said. The rules included “good things,” Jackson said, but it was a mixed bag and ultimately not on par with common sense.
“I think the entire access rule will probably be removed,” Landers said. “There's something out there that our community wants to maintain, but in the end I think it's good news when I sleep because the 80/20 production is so damaging and ineffective.”
By repealing this rule, providers can make their own decisions in Medicaid dollars. But in my eyes, balancing rule removal needs to involve other changes that allow the benefits of home therapy to provide the desired benefits to employees. If businesses are fully refunded, they can provide insurance and other benefits to workers, Landers said during discussion.
The budget bill's Medicaid cuts and the recently proposed Medicare home payment rules make it seem weak for hopes for adequate reimbursement, but lawmakers cross the fingers of repealing the 80/20 rule to improve workers' status and taking action while protecting workers.
Surviving refunds, regulatory pressures
Some policy changes promise to mitigate the challenges facing the home care sector, but if the 2026 CMS Medicare proposal is finalised, if providers continue to struggle with the Medicare advantage rate, or if they are exacerbated by the potential trictown effect of a major Medicaid cut.
Weinz and Jackson said preparing the business for changes to their hands is a top priority.
For a home choice, Jackson has taken up two main approaches to alleviating some of the pressure. The first is diversifying services.
“You choose, I've been very focused on building three different service lines: personal care, home hygiene and hospice,” Jackson said. “Diversity is one way of hedging against pen risk regulation stroke. Steve's point is that they're insufficient funds, so when they start moving around the dollar, they become the point of the state.
In addition to diversifying the line of service, options have made greater strides in incorporating artificial intelligence into all aspects of the back office.
“We have discovered that we are trying to reinforce what we are doing, very quietly in the home health sector, improving approval processing and even automating how approvals are progressing. “If you're not doing that now, our most valuable resources are caregivers and clinicians, and simply not enough for them.”
Executive Homecare focuses on strategic training, including sales training, helping franchise brands themselves to “work outside the box,” with maximizing private payment revenues being the main goal.
“We really focus on community, relationships and training so we can get them to have more of that private wage sector, which helps us maintain our margins.”
Caring for more private payment clients may be best for franchises keen to embrace MA.
“Many of my franchises want to start with Medicare advantage,” Weinz said. “Once you start it, they're very excited about it, but it's not sustainable, because then they understand what their margins are in part of it. So there's definitely something because we can afford these things because with the Medicare advantage, their pricing, their refunds to raise it.”
Another way providers can take action is linked to the Trump administration's stabilization of fraud, waste and abuse. This is the area that should ultimately benefit the sector if bad actors are ingrained. Some fake companies or marginal operations exist in care spaces at home locations and should be targeted by CMS, Landers said. However, in the near future, providers will need to make the necessary investments in technology and operations to ensure compliance.
Regulators should not compromise on accessibility of good attention due to administrative issues like missed signing, Jackson and Landers said. To thrive under the increased audit, providers should have a “robust audit and loss prevention program,” Jackson said.
“We need to look at programs that will help improve compliance with clean claims,” Jackson said. “I think you have to be perfect there.”
The providers who succeed here can stand out from their peers, Landers said.
“This is very important in this environment and it's a differentiator for people: compliance and internal control,” Landers said. “This administration, as we see, is very serious about moving forward with the cause of eliminating waste, fraud and abuse in healthcare to Congress. They really show how violently they prioritize fraud and abuse prevention.”
Providers look over the shoulders of workers and look more and more for software solutions that will help ensure full compliance.
Finally, and perhaps most importantly, providers can take action to bridge the communication gap between lawmakers and providers. Weinz, Landers and Jackson all defended the cost-saving nature of home care. Lawmakers are still proving that home care could be a tool to help them achieve better outcomes and cost-saving goals.
So providers must use voices, Landers said.
“It is essential to include speaking up, telling stories, engaging with legislators and making a difference with the associations of states and nations,” Landers said. “We see grassroots participation and political action becoming stronger. It's not strong enough. We have to continue, but there's momentum there and we have to continue investing.”
