Choice Health at Home’s CEO, David Jackson, envisions his rapidly-growing business as among the largest home-based post-acute care businesses within the next five years.

To achieve this goal, Jackson has laid out a strategy that includes “matching the market” in terms of Medicare Advantage, a hub-and-spoke density model and a three-pronged service foundation, according to the latest episode of HHCN+ TALKS.

“We want all three segments in five years to be the size of our business today,” Jackson said. “With that balance, we think we can better serve communities.”

Tyler, Texas-based Choice Health at Home provides home health, hospice and personal care and rehabilitation services in nine states.

Jackson aims to double Choice’s footprint in the Southwest, while building out its newer footholds across the country. Choice recently moved into the Southeast with Florida-based acquisitions, and shared during TALKS that Choice recently “quietly” moved into Washington. He expects the volumes in the Pacific Northwest will be slightly smaller than Choice’s other regional markets, but that Choice can build density in these geographies and work toward having a home-based care continuum.

Specifically, Jackson wants a balanced care continuum that includes home health, hospice and personal care services. This three-pronged pursuit can be difficult, he said, especially when dealing with Certificates of Need (CON), but Choice continues to pursue balance.

Some of these service lines may have a hotter acquisition market at any given time, he said, but he aims to be disciplined and achieve all three service lines in each territory — creating a three-legged stool.

Dealmaking in the overall home-based care industry declined in Q2 2026, according to Mertz Taggart’s Q2 2026 home-based care M&A report. Six home health deals closed in the quarter, compared to eight home care deals.

For Choice, personal care remains an attractive M&A target, even though others’ interest in the space may have waned because of the One Big Beautiful Bill, which threatened states’ Medicaid budgets.

Reimbursement strategy

On the reimbursement front, Jackson rejects the idea of avoiding a payer type that providers have often criticized for lower reimbursement and utilization-management friction compared with traditional Medicare: Medicare Advantage. Instead, his strategy for Choice is to “match the market.”

“We want to serve the markets we serve,” Jackson said. “If it’s 50% Medicare Advantage penetration, we want to strive to be 50% Medicare Advantage penetration. We think it is somewhat foolish to stick your head in the sand and say, “Hey, we’re just not going to treat those patients.” We are going to continue to work to have contracts that reward the level of care that we provide.”

Still, friction exists when contracting with Medicare Advantage plans, Jackson said. Clinicians in the field are forced to advocate for their patients if Medicare Advantage plans disagree that patients need additional visits. Choice’s leadership is focused on more regulation regarding the care these patients are entitled to, Jackson said.

While continuing to hope for improvements on the Medicare Advantage program, Jackson sees the recently proposed Medicare home health payment rule as an exciting change to the home health payment narrative.

The rule, proposed by the Centers for Medicare & Medicaid Services (CMS) on July 1, includes an aggregate payment increase of 2.4%, or $420 million. Providers and industry experts hailed the rule as a positive sign for the industry, while noting that previous permanent adjustments and the continuation of temporary adjustments were unsustainable for the industry.

Jackson said he hoped to see clarity on the temporary adjustments that would allow Choice to plan further into the future.

”At Choice, we anticipate that [clarity] being [in] 2028,” Jackson said. “We think that we should start seeing these positive aggregate payment increases potentially pull back on the temporary adjustments.”

Growth progress and goals

Choice has been an active acquirer in the home-based care space, completing 53 acquisitions, including 24 since 2020.

The company’s acquisitions typically follow a specific pattern, Jackson said. Choice will acquire businesses representing each one of its service lines in turn. For example, Choice acquired a hospice before acquiring a personal care provider, and then acquired a home health provider. In a few months, Choice will integrate another hospice business, he said. This avoids adding stress to the company’s operational team, he said.

“The rationale, when you think about it from that angle, is pretty simple,” Jackson said. “It’s like, ‘Hey, give your ops teams time to integrate before you come back behind with another acquisition in the same space.’ It doesn’t always work that way. Oftentimes, home health and hospice businesses are running together. For the most part, they’re more leaned towards one segment or the other.”

When considering the geographic element of an acquisition strategy, Jackson aims to build density within Choice’s markets. The CEO employs a hub-and-spoke approach, using large urban markets as hubs, which then allows Choice to create successful satellite offices in rural markets.

As an example of the type of density he looks for, Jackson said that Choice’s Florida census climbed to well over 2,000 total patients in a few months. The different providers that Choice acquired within the state overlap in a way that allows Jackson to optimize operations and give the company solid footing in the state, he said.

Even CMS’ six-month moratorium on Medicare home health enrollment will not slow Choice’s growth trajectory, Jackson said. The moratorium does have the benefit of blocking bad actors, but it impedes the development of new agencies in rural markets. But for Choice and similar organizations, the moratorium is not a significant barrier to achieving meaningful growth goals.

“This type of rule doesn’t really slow down big businesses, because we will come in and we’ll buy license numbers, buy established businesses,” Jackson said. “We’re going to look at compliance right out of the gate. That’s how we’re going to build our business.”