In the heart of the American healthcare system, home health care serves as an indispensable lifeline, delivering personalized and cost-effective support to millions of individuals right where they live. As the population ages and chronic illnesses become more prevalent, the demand for these services surges, placing immense pressure on providers to meet needs amidst mounting challenges. Systemic barriers, from funding shortages to regulatory hurdles, threaten to erode access and quality, making advocacy not just important but urgent. The National Alliance for Care at Home, representing over 1,500 organizations and 10,000 agencies nationwide, stands at the forefront of this battle, pushing for reforms to secure a sustainable future for home-based care. Their mission centers on ensuring high-quality, person-centered services for seniors, individuals with disabilities, and those nearing the end of life, drawing attention to both the profound human impact and the stark data underscoring the need for change.
The value of home health care lies in its ability to offer a deeply personal approach, allowing providers to understand patients’ lives in ways institutional settings often cannot. This unique perspective fosters community integration and supports individuals during some of their most vulnerable moments. The resilience of this sector shone brightly during the COVID-19 pandemic, as providers adapted swiftly to maintain care despite unprecedented obstacles. However, persistent issues like inadequate reimbursement rates and misguided policy proposals risk undoing this progress, particularly for rural residents and low-income families who rely heavily on these services. The growing acknowledgment of home-based care as a vital component of modern healthcare fuels the push for reform, with policymakers recognizing its potential to lower costs compared to hospitals or nursing homes. Yet, without targeted interventions, the sector struggles to keep pace with rising demand while preserving its compassionate, tailored approach.
Critical Issues Facing Home Health Services
Systemic Barriers to Sustainability
The financial foundation of home health care is under siege, with funding shortfalls posing a direct threat to the survival of many agencies. Insufficient reimbursement rates from Medicare and other programs fail to cover the true cost of delivering care, leaving providers stretched thin. A proposed 9% reduction in Medicare payments for 2026, amounting to over $1.1 billion, exacerbates this crisis. Such cuts, based on questionable calculations, could force closures in communities already grappling with limited access—half of U.S. counties have lost providers in recent years. The ripple effects are profound, leading to longer wait times for patients and diminished care during critical recovery periods. This financial instability not only jeopardizes the livelihoods of dedicated professionals but also undermines the very premise of home-based care as a viable alternative to institutional settings.
Beyond funding, regulatory missteps add another layer of complexity to an already strained system. Proposals to integrate hospice services into Medicare Advantage plans, often referred to as a “carve-in,” risk creating unnecessary barriers for patients seeking end-of-life care. This shift would transfer administration from traditional Medicare to private plans, potentially limiting patient choice and burdening providers with additional administrative tasks. Small and rural hospice agencies, many of which lack contracts with Medicare Advantage, face the greatest risk of exclusion. Such policies overlook the fact that hospice already functions as a managed care model specifically designed for end-of-life needs, rendering added oversight redundant and counterproductive. The convergence of these financial and regulatory challenges paints a stark picture of a sector at a crossroads, where the failure to act could deepen existing disparities in access and quality across the nation.
Broader Impacts on Vulnerable Populations
The consequences of these systemic issues disproportionately affect the most vulnerable segments of society, including seniors and low-income families who depend on home health care as a lifeline. When agencies close due to financial pressures, rural communities often bear the brunt, as alternative care options are scarce or geographically distant. This lack of access forces individuals into more expensive institutional settings, contradicting the cost-saving potential of home-based services. Moreover, long waitlists—already a reality for over 700,000 people seeking Medicaid home- and community-based services—grow even longer, delaying critical support for those with chronic conditions or disabilities. The human toll of such gaps is immeasurable, as patients lose the dignity and comfort of receiving care in familiar surroundings.
Workforce challenges further compound these problems, as low reimbursement rates hinder agencies’ ability to offer competitive wages. High turnover and staffing shortages have become commonplace, reducing the consistency and quality of care provided. For families already navigating the emotional and logistical burdens of caregiving, these disruptions add unnecessary stress and uncertainty. The intersection of financial, regulatory, and workforce barriers creates a vicious cycle, where diminished resources lead to poorer outcomes, further straining an overburdened system. Addressing these intertwined issues requires a comprehensive approach that prioritizes both immediate relief and long-term stability, ensuring that the most vulnerable are not left behind in the push for reform. Advocacy efforts must amplify these voices to drive meaningful change on a national scale.
Strategic Advocacy Efforts for Reform
Protecting Medicare Home Health Funding
One of the most pressing battles in home health advocacy centers on safeguarding Medicare funding from devastating cuts. The proposed 9% reduction in payment rates for 2026, equaling over $1.1 billion, threatens the very existence of many agencies already operating on razor-thin margins. These cuts, rooted in flawed methodologies that disregard established laws, could accelerate agency closures, particularly in underserved areas where options are already limited. The fallout would mean longer wait times for patients recovering from surgeries or managing chronic conditions, effectively denying timely care to those in desperate need. To counter this, advocates are rallying behind the Home Health Stabilization Act of 2025, which seeks to pause these reductions for two years. This temporary reprieve would provide breathing room to develop more equitable, data-driven solutions that reflect the true cost of delivering care at home.
Preserving access to home health services goes beyond simply halting cuts; it requires a proactive defense of the infrastructure that supports millions of Americans. Agency closures not only disrupt care for current patients but also deter new providers from entering the market, creating long-term gaps in service availability. Rural and low-income communities, already facing significant healthcare disparities, stand to lose the most as waitlists grow and recovery periods extend without adequate support. The ripple effects extend to families, who often must shoulder additional caregiving burdens or seek costly alternatives. Legislative support for stabilizing funding is seen as a critical step to prevent these outcomes, ensuring that home health remains a viable option for those who prefer to age or heal in their own environments. Advocates emphasize that protecting this funding is not just a financial issue but a moral imperative to uphold patient dignity and choice.
Safeguarding the Medicare Hospice Benefit
Another cornerstone of advocacy focuses on preserving the autonomy of the Medicare Hospice Benefit from integration into Medicare Advantage plans. The proposed “carve-in” would shift oversight of hospice care from traditional Medicare to private plans, introducing significant risks to access and quality. Such a change could erect barriers for patients seeking end-of-life support, delaying critical services at a time when every moment counts. Additionally, it would limit patient choice by tying care to specific networks, often excluding small and rural providers who lack contracts with Medicare Advantage. These providers, vital to underserved areas, could face financial ruin under this model, further shrinking the hospice landscape. Advocates argue that hospice already operates as a specialized managed care system tailored to unique needs, making added layers of administration unnecessary and potentially harmful.
The push to maintain the current structure of the Medicare Hospice Benefit is grounded in a deep understanding of its value to patients and families. End-of-life care is profoundly personal, requiring flexibility and compassion that broad, one-size-fits-all plans may not accommodate. Introducing Medicare Advantage oversight risks prioritizing cost over care, with administrative burdens diverting resources from direct patient support. Rural hospice agencies, in particular, face an existential threat under this proposal, as their exclusion from networks could force closures and leave entire communities without essential services. Legislative action to reject this integration is seen as vital to protecting the integrity of hospice care, ensuring that it remains responsive to individual needs rather than corporate interests. The call is clear: preserve the existing framework to safeguard choice and access for those at life’s most fragile stage.
Strengthening Medicaid Home- and Community-Based Services (HCBS)
Underfunding of Medicaid home- and community-based services represents a critical gap in the home health ecosystem, leaving over 700,000 individuals on waitlists each year. Low reimbursement rates make it nearly impossible for agencies to cover operational costs, let alone offer competitive wages to attract and retain staff. This chronic shortfall fuels workforce shortages and high turnover, disrupting care continuity for vulnerable populations who rely on these services to remain independent. Without adequate support, many are forced into institutional settings that are not only more expensive but also less aligned with personal preferences. Advocates are pressing Congress to increase funding for HCBS, arguing that such investment is essential to expand access and stabilize the provider network, ultimately benefiting both patients and the broader healthcare system by reducing reliance on costlier alternatives.
The urgency to bolster HCBS extends beyond mere numbers; it touches on the fundamental right to live with dignity in one’s own community. Years-long waitlists mean that individuals with disabilities or chronic conditions often go without the support needed to manage daily life, placing immense strain on families and caregivers. Enhanced funding could break this cycle by enabling agencies to hire and train more staff, thereby reducing turnover and improving care quality. Moreover, it would affirm the cost-effectiveness of home-based care over nursing homes or hospitals, aligning with national goals to manage healthcare spending. Legislative support for HCBS is not just about addressing immediate shortages but also about building a resilient framework that can meet future demand as the population ages. Advocates highlight that strengthening this program is a step toward equity, ensuring that financial barriers do not dictate access to essential care.
Expanding Telehealth Access
Telehealth has emerged as a transformative tool in home health care, particularly for patients in rural areas or urban centers with high traffic constraints. By leveraging technology, providers can supplement in-person visits with virtual consultations, ensuring continuity of care for seniors and others with mobility challenges. However, the temporary flexibilities introduced during the COVID-19 pandemic remain at risk of expiration, threatening to disrupt established care models. Such a rollback would burden providers with logistical challenges and leave patients without a critical lifeline. Advocates are championing legislation like the CONNECT Act to make these telehealth provisions permanent, arguing that sustained access to digital care is vital for innovation and equity in healthcare delivery across diverse communities.
The push for permanent telehealth flexibilities reflects a broader recognition of technology’s role in modernizing home health services. Virtual platforms enable real-time monitoring and intervention, reducing the need for costly emergency visits while empowering patients to manage their health from home. For rural providers, telehealth bridges geographic divides, connecting isolated individuals with specialists who might otherwise be inaccessible. The expiration of current policies would not only halt this progress but also widen disparities, as those without easy access to in-person care would suffer most. Supporting bills like the CONNECT Act is seen as a forward-thinking move to integrate technology into the fabric of home-based care, ensuring that innovation keeps pace with demand. This advocacy effort underscores a commitment to adaptability, prioritizing solutions that meet patients where they are—both physically and technologically.
Path Forward for Home Health Advocacy
Building a Collective Movement
Reflecting on the strides made, the advocacy journey for home health care reveals a landscape of both challenge and opportunity. The National Alliance for Care at Home spearheaded efforts that brought over 230 providers and leaders to Washington, D.C., engaging in hundreds of congressional meetings to highlight urgent policy needs. These interactions underscored the power of grassroots and grasstops initiatives in shaping a dialogue around funding, hospice autonomy, Medicaid support, and telehealth access. Each conversation built momentum, amplifying the voices of patients, families, and providers who face the daily realities of systemic shortcomings. The commitment to oppose payment cuts, reject regulatory overreach, and champion innovation through technology stands as a testament to the sector’s resolve to protect compassionate, person-centered care.
Shaping Sustainable Solutions
Looking ahead, the focus must shift to actionable steps that translate past advocacy into lasting impact. Policymakers should prioritize legislation like the Home Health Stabilization Act of 2025 and the CONNECT Act to address immediate threats while laying the groundwork for systemic reform. Beyond legislative wins, fostering partnerships between providers, vendors, and community stakeholders can strengthen the ecosystem of home-based care, ensuring resources and expertise are shared effectively. Investment in workforce development, through better wages and training supported by enhanced Medicaid funding, remains critical to meeting future demand. Additionally, embracing technology as a permanent fixture in care delivery can bridge gaps in access, particularly for underserved regions. By uniting around these priorities, the collective effort can ensure that home health care evolves into a robust, equitable system that upholds dignity and choice for every American in need.
