Home-based care providers are feeling the squeeze from Medicare Advantage and Medicaid — and some are responding by limiting admissions for certain payers.

When it comes to Medicare Advantage, providers experience a range of pains beyond just rates, including administrative burden, prior authorization delays and care denials and appeals. That’s according to a survey conducted by Home Health Care News in anticipation of the PAYER Summit taking place in Chicago from June 17-18. 

Of the survey respondents, 88% worked for organizations offering at least one home-based service line, including skilled home health, at-home non-clinical personal care or SNF-at-home. Respondents primarily held senior roles, including leadership or clinical leadership roles.

Medicare Advantage often reimburses for home-based care services at lower rates than traditional Medicare fee-for-service. Data from the technology and administrative services company Homecare Homebase indicate a 38% delta between traditional Medicare and Medicare Advantage. 

Providers are feeling that delta. More than half – 56.2% – of survey respondents reported that Medicare Advantage is the payer type exerting the most pressure on their organizations, nearly twice the rate of the next-closest payer, Medicaid, at 31%.

Low reimbursement rates remain top of mind, cited as a top-two MA challenge by 56% of respondents. But rates are far from the only pain point. General administrative burden was one of the top two challenges associated with Medicare Advantage for 43.8% of respondents. Prior authorizations and delays were among the top challenges for 37.5% of respondents, as were denials.

Medicaid was also a sore spot for a significant portion of providers, with 31% naming it as the payer type applying the most financial pressure. Looking ahead to 2027, rate cuts and inadequate updates emerged as the top Medicaid-related risk, cited by 31% of survey respondents. Eligibility redeterminations and coverage churn and denials/audits/recoupments each followed at 19%. Payment delays rounded out the list at 13%.

Many respondents reported that reimbursement rates across payer types were inadequate, with 50% saying their rates were somewhat or very inadequate. Some, 18.8%, said their reimbursement rates were neutral, and 31.3% said they were somewhat adequate. No respondents reported that their rates were very adequate.

Higher rates were also ranked as the most likely to improve financial sustainability, with 75% of respondents saying that higher base rates were among the top two changes most likely to improve it across all payer types. Respondents were next focused on prior authorization burdens, with 43.8% reporting that reductions in prior authorization requirements would most improve financial burden.

Some home-based care providers have reported netting reimbursement rate wins in recent months. Aveanna Healthcare Holdings (NASDAQ: AVAH) has notched several rate increases recently, and leadership expects mid-single-digit state rate increases in 2026. Addus HomeCare Corporation (Nasdaq: ADUS) has also reported favorable rate increases, including a rate increase in the state of Illinois, which company leadership expects will add approximately $17.5 million to the company’s annualized revenues. 

But reimbursement issues persist, and providers are taking action in response. Three-fourths of respondents said that in the past 12 months they have limited new admissions for certain payers, primarily due to payer reimbursement or administrative burden. Another 25% said they increased billing or revenue cycle management staffing or outsourced these tasks, and 18.8% said they reduced certain services due to payer challenges.

To register for the PAYER Summit taking place June 17-18 in Chicago, click here.