As proposed sweeping rate cuts are poised to transform the home health industry drastically, leaders are finding ways to safeguard care quality and access.

Maintaining a staff of home health workers who are ready to practice at the top of their license, through revamped virtual case management models or by connecting workers to their “why,” can help providers looking to increase efficiency in the face of the proposed 2026 home health rate cut. Still, pushing back against the proposed 2026 Medicare home health rate cut is critical to allowing providers to maintain strong workforces.

“It’s a misguided policy,” Dr. Steven Landers, CEO of the National Alliance for Care at Home (the Alliance), said at the 2025 National Alliance for Care at Home Financial Summit. “It’s dangerous. It’s going to hurt people.”

While the Centers for Medicare and Medicaid Services seeks to be budget neutral and modernize the home health payment system, cutting rates for home health “makes no sense,” Landers said.

“Somehow, in 2019, … the home health payment system was a $17.8 billion program, and now this year, it’s going to be a $15 billion program, and much less valuable dollars than they were in 2019,” Landers said. “We’ve got delays in care, agency closures, rural access issues. It makes no sense.”

While home health is being “decimated” and access to services declines, instances of potential fraud are present in some parts of the U.S., Landers said. He suggested that CMS take on these “obvious inefficiencies” while supporting legitimate providers.

Unique to the home health industry is CMS’ ability to recoup overpayments in a particular year, according to Hillary Loeffler, vice president of policy and regulatory affairs at the Alliance. Recoupments from 2020 to 2024 total $5.3 billion, Loeffler said. CMS will begin the recoupment process in 2025, representing an additional 5% cut on top of a 4% rate adjustment. 

“That’s a crisis point for our industry,” Loeffler said. “The baseline total expenditures in the Medicare program for home health is going to be around $15 billion that year. For us to owe CMS $5 billion in overpayments is, frankly, astronomical. We have serious issues with their methodology, and we’re going to do everything we can to hopefully get them to see the light on this.”

Workforce strategies

In the face of such cost pressures, providers must focus on efficiency.

Improving retention and staff productivity are key strategies to doing so, as well as allowing workers to practice at the top of their license. Creating a strong culture and reminding staff about why they chose to work in their field are priorities for CommonSpirit Health at Home, according to Trisha Crissman, the company’s CEO.

“Probably the number one focus for our organization when it comes to our workforce clinicians in the field is the increasing need and urgency to continue to help them connect to their ‘why’, especially as patients come to us who are much more acute than they used to be,” Crissman said.

Milford, Ohio-based CommonSpirit Health at Home offers specialized home care, home infusion, hospice and medical transportation services from 83 locations across 13 states. The company is the home-based care arm of health system CommonSpirit Health.

To connect workers to their “why,” Crissman said CommonSpirit has updated its virtual case management model. The company predicts that it can add 2,200 more starts of care for home health with senior staff, which Crissman said was “significant.” The organization is also seeking to ensure paraprofessional ratios are healthy.

Creating a positive environment will also encourage workers to join, Crissman said.

While Crissman said the company has achieved its lowest turnover rate in a decade, she is still “nervous.”

“I’m nervous about when, not if, but when, our employees, my clinicians, will come to the awareness that possibly I don’t have all of the bells and whistles layered onto technology and how they go about their work to make their lives easier, because I can’t afford it,” Crissman said. “So I have to figure out how to afford it, which means I have to continue to ask deeper questions about how, not if, we’re going to improve efficiency and productivity with the staff I already have.”

Some potential regulatory changes could improve the workforce status quo, according to Landers. The Trump administration’s deregulation agenda – including proposed changes to the Fair Labor Standards Act (FLSA) and the potential repeal of the 80/20 rule – could be helpful for home health agencies’ workforce woes.

“Deregulation is potentially a way to support our creativity and our ability to innovate and maneuver reimbursement policy,” Landers said. “Reimbursement policy is workforce policy. It’s the purchasing power that the providers have to be able to put those angels on the front line.”