Home-based care providers are facing reimbursement challenges on multiple fronts – necessitating layoffs and other tough strategic decisions.

In light of the upcoming 2026 home health final payment rule, Medicaid funding cuts from the One Big Beautiful Bill and more, companies such as Healthview Home Health and Bryan Skilled Home Care are beefing up their advocacy efforts and leaning into their strengths to navigate choppy reimbursement waters.

As a company providing care to Medicaid-managed long-term care and NHTD/TBI waiver participants, Bryan Skilled Home Care is preparing to operate in an environment with less money in the system.

“That’s gonna mean harder negotiations,” Bryan Madden, CEO of Bryan Skilled Home Care, said at Health Care News’ FUTURE conference. “What do we do when it’s a little bit harder to negotiate? Over the course of years, we really learn to accentuate what we do well.”

New York-based Bryan Skilled Home Care is a personal care and skilled nursing provider that is licensed by the New York State Department of Health. The company operates in Long Island and Queens.

For Bryan Skilled Home Care, accentuating what the company does well means leaning into its best metric.

“We don’t miss visits,” Madden said. “It’s pretty simple. That then leads to better patient satisfaction and [fewer] complaints to the payer. Articulate what you do well.”

Healthview CEO Steven Gonzalez is aware of the dangers of a 6.4% cut to home health payments. This is why the company spent time advocating on behalf of the industry on Capitol Hill in August.

“It was a pretty successful outing for home health, hospice and telemedicine,” Gonzalez said during the discussion. “We’re preparing for the 6% decrease, it’s kind of more like 9% if it actually happens over the last few years. We’ve already started that operational efficiency piece to capture that 6%, so if that stabilization letter does get approved, that should freeze the rate cut for the next year; it would be like a plus for us.”

Founded in 1967, HealthView is a Cerritos, California-based provider offering home-based care services including private duty nursing, skilled nursing, personal and companionship and other home-based services.

To achieve operational efficiency, HealthView has embraced technology. However, the company is still feeling the impact of an unstable reimbursement environment.

“You can 10x an employee by amplifying them with technology, but the reality is, we did have to lay people off, just like a lot of other home health [companies] had to do,” Gonzalez said. “That was something we did talk with Congress about last week, and our Senate [in] California.”

Alternative solutions

Hillary Loeffler, vice president of policy and regulatory affairs at the National Alliance for Care at Home (the Alliance), noted that the organization has been pushing for the administration and Congress to revisit their methodology for home health payment cuts.

“We don’t believe that they’re calculating the reductions appropriately and following the intent of the statute,” she said during the discussion. “If this were to get finalized as proposed, we would have to transition to Plan B, which is hopefully to lean on our congressional champions, who just recently introduced the Home Health Stabilization Act of 2025.”

The Home Health Stabilization Act of 2025 was introduced by Representatives Kevin Hern (R-Okla.) and Terri Sewell (D-Ala.) in September. The legislation would pause reimbursement rate cuts for the next two years.

Loeffler explained that the bill would also give the industry time to work on comprehensive reform to permanently address the rate cuts. Though she estimated that CMS will likely finalize a less severe version of the proposed rule, she stated that a softened cut would not sufficiently improve home health’s operating environment.

“I think they’ll probably back off, but to me, success isn’t just cutting it in half or backing off,” Loeffler said. “They really need to revisit the methodology. Right now, the temporary adjustment that they proposed to 5% that’s to start recouping $5 billion from the industry, and unless they change their methodology and how they’re calculating these cuts, which we think they’re making mistakes on, we’re just facing seven, eight, nine more years of 5% cuts to our rates, which is completely not sustainable for the industry.”

Loeffler encourages home-based care providers to keep fighting.

“The squeaky wheel tends to get the grease, and I think with home health, we need to make our voices heard more loudly and more frequently,” she said. “I encourage everyone here to reach out to their members of Congress, their senators, their representatives. Call them, write emails, and write letters. If you’re ever in DC, schedule a meeting with your representative.”

Bryan Skilled Home Care has also helped draft a bill for a minimum reimbursement for Medicaid managed care, which Madden said would be “hugely important” to the organization. Madden is also heavily involved with the New York State Association of Health Care Providers.

“We bring in a state senator or assembly person to just educate them on what’s happening, currently, in the industry, just raising their awareness,” he said. “I think it’s easy for people to forget how important home care is to a normally functioning society.”