Last week, the U.S. Department of Labor (DOL) formally rescinded the 2024 overtime rule that would have significantly expanded overtime eligibility, and reverted to the 2019 salary threshold framework.

The 2024 rule was finalized and partially went into effect in 2024, but courts vacated the rule after the first salary threshold increase. Now, the rule has been formally revoked.

The move changes the lower salary threshold for overtime pay to $35,568, instead of the planned $58,656. If the 2024 overtime rule had fully gone into effect as designed, home-based care employers would have had to reclassify several roles as non-exempt.

This rescission reduces near-term labor costs and compliance pressure for home-based care providers – but it doesn’t solve the industry’s labor problem. In the long term, providers must find ways to improve retention and advocate for better reimbursement.

The rescission also includes a tradeoff for providers: risk of burnout for workers in a stretched-thin labor market.

In this week’s exclusive, members-only HHCN+ Update, I’ll unpack what reverting to the 2019 salary framework means for the home-based care industry, offering analysis and key takeaways, including:

– The flexibility the DOL’s rescission gives providers

– The tradeoff for this flexibility

– The safe staffing play

More flexibility in how work gets done

The rescission of the 2024 rule offers home-based care providers several benefits, but the importance of all of these can be boiled down to flexibility.

The rule means fewer employees must be paid overtime, which allows employers to let their workers flex their hours week to week. Employees can answer calls after hours without triggering overtime, and don’t have to track every minute.

This also potentially reduces compliance risk compared with what might have happened if the 2024 rule had been fully implemented. In that case, more hourly non-exempt staff would require stricter time tracking and could pose a compliance risk if they work off the clock.

Employers may now have to worry less about monitoring off-the-clock work, which could save on administrative costs. It will also be less critical to ensure that workers below the 2024 salary threshold but above the 2019 threshold are scheduled in a way that most avoids unplanned overtime.

Having fewer people in the non-exempt category means less overhead managing staffing costs. So lowering the threshold lets providers operate with more flexibility and less administrative friction.

The tradeoff

For home-based care providers, lowering the threshold doesn’t change how much work needs to get done — it changes how much of that work shows up on the payroll. The work will still get done. After-hours calls will still happen. Documentation will still spill over. And the same supervisors, coordinators and managers who would have been swept into overtime eligibility under the 2024 rule can still end up working 45–55 hour weeks.

From where I sit, that’s exactly why this can’t be treated as a “workforce fix.” One of the highest-priority problems in home-based care is still retention.

We’ve seen some encouraging signs about the workforce status quo in recent history. The news from the DOL implicates mostly salaried “white-collar” roles (supervisors, managers, coordinators), but I think it’s helpful to look at retention metrics in home-based care to get a picture of what’s working right now. The lesson we can learn from the front lines is clear: pay can move needles. Last year, I covered a report showing that turnover rates among home care aides (HCAs) and certified nursing assistants (CNAs) had dropped due to pay increases. In 2025, the national average hourly rate for HCAs and CNAs increased by 4.93%, compared to 4.86% in 2024. Sign-on bonuses for HCAs also increased, from $2,129 in 2024 to $2,304 in 2025.

These pay bumps led to a drop in turnover for HCAs and CNAs, from 36.31% in 2024 to 34.17% in 2025. Such statistics are encouraging, especially when providers have poured time and money into methods to retain workers like gamification, paid time off (PTO) and worker training. 

While these statistics show some improvement in the retention beast, the cause of this bump was chalked up to pay. If at least part of retention improvement is rooted in pay, then the long-term “win” from a lower salary threshold is not automatic. Yes, balance sheets may look better in the short term if fewer salaried roles become overtime-eligible. But if that relief is converted into more uncompensated hours, the problem could just change to increased turnover.

But provider execs also tell me regularly that what keeps their employees isn’t pay. I often hear that flexibility, benefits and training are often more important than pay in their workers’ minds. And I think that comes down to my main point here: if you’re going to take advantage of “flexibility” in labor rules, you have to pair it with intentional recognition and rewards, so flexibility doesn’t become a euphemism for “always on.”

This is also where the importance of technological evolution within home-based care comes into play. I have heard from provider execs on multiple occasions that they are trying to reduce “pajama time,” in which workers finish their shifts only to go home and have to finish notes when they would ideally be putting their feet up or spending time with family and friends. Efficiency tools can reduce workload and problems like pajama time.

So DOL’s move is a short-term win for providers, in that it reduces immediate payroll exposure and compliance disruption. But the providers who benefit most will be those who treat it as a temporary pressure release, not a solution. Reimbursement still sets the ceiling for what the industry can sustainably pay. Retention is still the fight. And unless employers use this moment to double down with investments in smarter workflows, better technology and a more deliberate total benefits package, the workforce math doesn’t change.

The post DOL’s Overtime Rule Offers At-Home Care Providers Relief, But Does Not Solve Root Problem appeared first on Home Health Care News.

The lawmakers’ framework, released on Wednesday, could improve access to care, increase efficiency, and create a more stable payment source for providers – but questions remain about what the framework’s details would entail.

“Adding a meaningful home care benefit to Medicare would be a major policy shift,” Jason Lee, CEO of the Home Care Association of America (the HCAOA), told Home Health Care News in an email. “For providers, it could create a more consistent pathway to serve Medicare beneficiaries who need help with activities of daily living and other non-medical supports that allow them to remain safely at home. … Coverage [for these services is] limited, and families often have to pay privately, rely on unpaid family caregivers or spend down into Medicaid. A Medicare home care benefit could help close that gap, but the details will matter.”

Senate Finance Committee Ranking Member Ron Wyden (D-Ore.) and 16 other Senate Democrats outlined their proposal to Senate colleagues in a letter. The letter’s three goals are to make home care affordable and accessible, improve the quality of care in nursing homes and use incentives to strengthen the long-term care workforce. 

“America is failing people who are aging and those with disabilities, who should have every opportunity to live at home and thrive in their communities,” the senators wrote. “Democrats want to ensure American families have affordable, high-quality care in the setting they choose and quality jobs and living wages for direct care workers. Families that rely on nursing homes should have the peace of mind that their loved ones will receive quality care, and incentives should reward safe staffing. We want to ensure the Senate is prepared to act on these issues when Democrats have another opportunity to enact the bold, meaningful change the American people demand and deserve.”

Senators wrote that they would expand access to home care, build on innovative volunteer models that mobilize community members to care for one another, ensure that home care is a dependable and integrated part of the health care system and guarantee middle-income families access to care without depleting their savings.

The policymakers also shared a flash sheet describing President Donald Trump’s “attack” on home care. The document claimed that Trump slashed Medicaid and therefore harmed access to home care, reduced protections on nursing home care and worsened the long-term care workforce crisis, among other points. 

The potential benefits and the necessary steps of Medicare home care

While home-based care associations highlighted that the lawmakers’ framework could provide advantages to both beneficiaries and providers, the lack of clarity on the specifics of the plan means experts could only hazard their best guesses about what the proposal could mean for the home-based care industry.

“Right now, the Senators are looking for input on how to make that vision a reality, so thinking about specifics around what it would look like for specific providers to bill Medicare from an operational or logistical perspective is premature,” Mollie Gurian, vice president of policy and government affairs at LeadingAge, told HHCN in an email.

Home care providers would benefit from the expansion of services as well as the predictable, uniform coverage policies across the country that Medicare would offer, Damon Terzaghi, the vice president of Medicaid and home care policy at the National Alliance for Care at Home (the Alliance), told HHCN in an email.

“Additionally, this would be a great advancement for beneficiaries who currently have to divest themselves of assets in order to access long-term services in the community,” Terzaghi said. “Adding home care to Medicare would provide options that allow middle-class families to access needed care without impoverishing themselves – which is sorely needed in our country.”

As many providers offer a range of home-based care services, a home care Medicare benefit could lead to more comprehensive, coordinated care, increased system efficiency and improved service delivery, Terzaghi said.

The guarantee of home care services under Medicare could allow home care agencies to expand access and have a more stable payment source, Lee said.

Experts cautioned that lawmakers would need to implement a thoughtful plan to execute their framework.

From Gurian’s perspective, it would be critical to ensure beneficiaries have access to a range of HCBS supports. These could include home care, personal care, care management, transportation and adult day services.

The Medicare home care benefit would have to be designed to reflect the real cost of delivering care, Lee said.

“That means adequate reimbursement, reasonable administrative requirements, clear eligibility rules, and recognition of the workforce challenges providers are already facing,” Lee said. “A benefit that is underfunded or overly burdensome would not solve the access problem families are experiencing.”

Terzaghi added that the existing Medicare home health benefit – which he said is “woefully underutilized” – must be re-fortified through payment, eligibility and coverage modernization efforts.

Implications for expanding HCBS

Senators proposed that the Finance Committee staff develop policies to invest in Medicaid HCBS, but did not provide specifics on what these policies would entail.

Senators did write that these policies would “expand access to home care so families in need are not limited by waiting lists, astronomical out-of-pocket costs or arbitrary poverty thresholds that force families to hand over their hard-earned assets, like their family home, to qualify for services.”

While clear details on exactly how lawmakers will propose expanding Medicaid HCBS are lacking, such an expansion would likely resemble the recently reintroduced HCBS Access Act, according to Terzaghi. If the proposals holistically address challenges, including waiting lists for care, strict coverage limitations and low reimbursement rates, an expansion could increase HCBS access and allow more individuals to receive services in their communities, Terzaghi added.

If an HCBS expansion were combined with the addition of home care to Medicare, beneficiaries and providers could experience significant benefits, Gurian said.

“What an expansion of Medicaid HCBS looks like remains to be seen, but for example, if Medicaid HCBS becomes a mandatory part of the Medicaid program, there might be more opportunity for providers to expand their offerings since more beneficiaries would be eligible for access,” Gurian said. “Taken in tandem with a guarantee for Medicare beneficiaries, the potential to provide care across the spectrum of coverage is big, assuming appropriate reimbursement.”

Gurian, Lee and Terzaghi all specified that their organizations were eager to work with lawmakers on the proposal.

The post Senators Outline Plan For Medicare Home Care Benefit: What It Would Mean For Providers appeared first on Home Health Care News.

The Protecting Seniors and Stopping Fraudsters Act is designed to bolster Medicare oversight, crack down on scammers, protect seniors from fraudulent enrollments and improve accountability across the hospice and home health system, according to a statement emailed to Home Health Care News’ sister publication, Hospice News.

“Every single dollar stolen by criminals from Medicare is a dollar ripped away from a vulnerable senior who is just trying to spend their final days in comfort, peace and dignity,” Van Duyne said in the statement. “Americans are disgusted by the heartless actions of scammers treating these vital lifelines as personal ATMs and demand reforms to stop these criminals before they can steal precious taxpayer dollars, thereby further weakening the Medicare system.”

Among the bill’s goals is to build systems to identify bad actors earlier, particularly in geographic fraud hotspots like California, Nevada, Arizona and Texas. It would also focus regulatory action on providers with aberrant billing, discharge, enrollment, or low-quality reporting patterns rather than imposing blanket burdens across the industry, the statement indicated.

If enacted, the bill would increase survey frequency for hospices and home health agencies that are newly enrolled in Medicare, providers with ownership changes or those displaying signs of fraudulent behavior. It would also enhance screening requirements for providers considered to be at “extreme risk” of fraud, including fingerprinting administrators and medical directors and requiring proof of liability insurance.

The legislation would also take steps to improve accountability for accreditation organizations by requiring standardized survey training. It would also mandate notification requirements to alert seniors when they have been enrolled in hospice, with instructions on how to disenroll if fraud or abuse occurs. 

The Alliance has endorsed the legislation.

“My bill takes a proactive approach to stop fraud by strengthening oversight of high-risk hospice programs and home health agencies through enhanced enrollment screening, mandating more frequent surveys for new and suspicious providers, establishing stronger accreditation standards, and increasing transparency around enforcement activities,” Van Duyne said in the statement. “The Centers for Medicare & Medicaid Services needs and deserves these measures to fight the continued exploitation of services our seniors rely on.”

The post New Bill Targets Scams Within Home Health, Hospice Services appeared first on Home Health Care News.

As the Centers for Medicare & Medicaid Services’ (CMS) new moratoria affect only home health and hospice, Addus’ personal care services segment is not implicated, and the company’s home health segment’s growth strategy will be similarly unaffected, according to Dirk Allison, chairman of the board and CEO of Addus.

“We are not a de novo company,” Allison said at the RBC Capital Markets 2026 Global Healthcare Conference. “It’s been easier on the PCS side to buy the small operations. On the clinical side, we’ve not really participated in de novo growth, it’s always been M&A and pure organic growth. So I think from that standpoint, the moratorium has no effect on us.”

Allison’s prediction echoes statements made by Aveanna CEO Jeff Shaner, who said the company would feel “zero impact” from the home health moratorium. Other providers have stated that the enrollment freeze limits their growth levers and could reduce access to care.

Addus HomeCare primarily provides personal care services, as well as hospice and home health offerings. The company operates in 263 locations across 24 states, serving approximately 62,750 patients and consumers.

Potential home health acquisitions should not be affected as long as the target company qualifies under the 36-month rule, Allison said. He predicts that the moratorium will have little effect on valuations. 

Allison described CMS’ targeting of fraud, waste and abuse as beneficial to Addus and other large providers that spend millions of dollars annually on compliance efforts. Increased program integrity efforts will also pay off in payer negotiations, Allison predicted, because payers do not want to get involved with an out-of-compliance provider, making companies with large compliance programs more attractive.

Acquisition pipeline

Doubling down on comments made during the company’s Q1 earnings call, Allison said that Addus had several deals in its pipeline, including one or two deals, mainly personal care services-focused, that would be “very comparable” to the company’s $350 million acquisition of Gentiva’s personal care assets. 

“We’ve been … keeping our balance sheet clean, so if another type of Gentiva acquisition came up, we can do it very quickly and easily on an all-cash basis, through our line of credit,” Allison said. We think we will be discussing with people the potential of Addus being an acquirer. If you think about it, there are other acquirers, there are PE firms, but there’s just not a lot of large [personal care services] (PCS) companies out there that have the capacity with their debt coverage today, or their debt load today – not a lot of them can go out and do these bigger deals at this point in time.”

Addus’ most recent deal was its acquisition of Indiana-based HomeCourt Home Care. The company has also entered into a definitive purchase agreement with a similarly-sized personal care provider in Indiana.

Valuations have dipped since Addus’ acquisition of Gentiva assets, according to Allison. The CEO said that the Gentiva deal had a valuation of around 11 to 11.5, while deals made today will likely be sub-double digits.

“Because our stock has come down, and we’re probably, from a PCS standpoint, we’re the largest public company out there who does the type of business we do, which is agency business,” Allison said. “People have to look at our multiple, and you know we’re trading at under the double digits today. So I think that kind of leads to the valuation coming down a bit.”

The post Addus CEO: Moratorium Has Little To No Impact On Growth, Valuations appeared first on Home Health Care News.

The announcement comes three days after the private equity firm Kinderhook Industries closed on its acquisition of Enhabit and 10 months after former CEO Barb Jacobsmeyer announced her intention to step down from the role. 

“It is an honor to serve as CEO of Enhabit at such an important time in the company’s journey,” Clift said in a statement. “This is a great organization doing meaningful work, and I am proud to be part of its next chapter. Our people are the heart of Enhabit, and I am grateful for the opportunity to work alongside our talented team as we remain focused on delivering compassionate, high-quality care. I look forward to building on the company’s strong foundation and continuing to support our teams across the country.”

Clift served as CEO of Trilogy Home Healthcare for almost 10 years, and president and CEO of Nurse on Call for almost 11 years, according to his LinkedIn profile. Both organizations are Medicare-certified home health agencies. Nurse On Call was a Kinderhook investment that was exited in 2012.

Dallas-based Enhabit operates 251 home health locations and 117 hospice locations across 35 states.

Kinderhook’s acquisition of Enhabit, announced in February, took the company private.

“Dale is a proven leader with deep experience and a strong understanding of the home-based care landscape,” Chris Michalik, managing director at Kinderhook Industries, said. “His track record of building and scaling high-performing organizations speaks for itself, and we are confident he is the right leader to guide Enhabit forward as the company builds on its strong foundation and continues expanding what’s possible for patient care in the home.”

Clift’s predecessor, Jacobsmeyer, served as Enhabit’s CEO for five years. She previously served as executive vice president of operations for Encompass Health.

“I am proud of all that our team has accomplished,” Jacobsmeyer said. “With Kinderhook’s support and Dale’s leadership, Enhabit is well-positioned to continue growing its impact and serving even more patients who need and deserve our extraordinary care.”

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The post [Updated] Enhabit Names Dale Clift Its Next CEO appeared first on Home Health Care News.

Home health insiders have largely reacted positively to the Centers for Medicare & Medicaid Services’ (CMS) focus on fraud, waste and abuse in home health, but many have spoken out against the newly-instituted moratorium on home health and hospice Medicare enrollment.

Providers told Home Health Care News that the moratorium, which does not allow home health agencies to grow via de novo, will curb their abilities to grow their businesses – and can therefore limit access to care.

Dean Alverson, president and CEO of LifeCare Home Health Family, told HHCN that while the organization understands and supports efforts to curb fraud, the moratorium may unintentionally limit compliant providers’ ability to scale, invest in new communities and meet rising demand.

“The moratorium will impact our organization’s plans for growth and may affect broader operations,” Alverson wrote in an email. “We have been successfully expanding access to care through a de novo strategy, particularly in underserved and high-demand markets. Under the current moratorium, that approach will no longer be available, limiting our ability to respond to growing patient needs and to help offset existing shortfalls in access to home health and hospice services.”

Alverson said the moratoria could limit access to care in the short term – an outcome he added is not CMS’s intent – and argued that they are therefore not an appropriate approach to addressing home health or hospice fraud.

LifeCare Home Health offers Medicare-certified home health, private duty and hospice services through seven additional brands, serving communities in Texas, Florida, Nevada and Arizona.

For franchise home-based care provider Interim HealthCare, the focus will shift to supporting franchise partners in growing their businesses within their current geographies.

“The moratorium will impact our plans for expansion,” Rexanne Domico, president and CEO of Interim HealthCare. “We are a franchise network, and our local franchise partners serve their communities. Places where they live, work and participate in community activities. Places where they know care is needed and many are underserved. These types of providers will feel the pain of this overreaching decision more than larger national providers.”

Sunrise, Florida-based Interim provides home health, hospice, palliative and pediatric care, as well as medical staffing, through over 300 care centers.

Dan Borraga, the senior vice president of operations at Interim, said that the company completely agrees with the crackdown on fraudulent providers and advocates strongly for any program that weeds out the bad actors – but that the moratorium also harms compliant providers.

“A nationwide moratorium makes no sense in the current environment,” Borraga told HHCN in an email. “This move hurts local and national businesses that are playing by the rules, and it limits access for the people who desperately want to age in place and receive critical care services in the comfort of their homes.”

The moratorium does still allow for changes of ownership. But its move to prohibit providers from entering new geographies will most impact rural and underserved areas that do not currently have sufficient access to care, Hillary Loeffler, the vice president of policy and regulatory affairs at the National Alliance for Care at Home (the Alliance), told HHCN.

While still allowing for changes of ownership, the moratorium does raise questions for in-flight home health transactions.

“It’s really going to depend on the facts of the transaction and the target, its enrollment history and history,” Michelle Huntsman, a partner at Holland & Knight’s Houston health care law team, told HHCN. “Buyers need to be doing additional diligence and make sure they fully understand any prior changes of ownership that the target has undergone. They should also be doing very significant compliance reviews, because I anticipate transactions, change of ownership, will be on CMS radar for additional compliance reviews. I think that they should be prepared for processing times to be slower across the board.”

Providers should all aim to maintain a culture of compliance, Huntsman said, and ensure billing, coding is up to par. They should review the OIG’s compliance plan parameters, and understand how that compliance plan works in practice for their specific organization. They should bring questions to outside counsel, she continued.

The rationale behind the moratorium

During the six-month moratorium, CMS said that it would intensify investigations, deploy advanced data analytics and expedite the removal of suspected fraudulent providers. 

The moratorium signals a broader federal shift toward enforcement of compliance actions in the health care market, according to Huntsman.

“We will continue to see investigations, congressional hearings and just scrutiny of hospice and home health across the entire country,” Huntsman told HHCN.

CMS stated that the moratorium was instituted nationwide to prevent bad actors from simply shifting their operations across state lines. Loeffler questioned this logic.

“There’s not enough justification in CMS’ notice as to why they think this fraud problem is nationwide,” Loeffler said. “They declare that it is, but they really haven’t presented in our minds sufficient information to justify taking such a broad brush approach.”

The decision to put a moratorium on home health as well as hospice may have been made with a similar logic – to stop fraudulent hospice providers from simply shifting their operations to home health.

“If you’re going to crack down on hospice, I think maybe the fear of CMS is that it’s just going to shift to home health, so let’s do it together,” Loeffler said. “Because they are often co-located and intertwined.”

CMS has previously enacted a home health moratorium in 2013, which was extended and revised several times before eventually expiring in 2019. It is not out of the question that this new moratorium would also be extended longer than the initial six-month period, Huntsman said, and in fact is “somewhat likely” that it will be extended. 

Loeffler suggested that it is difficult to anticipate when CMS will lift the moratorium, because the agency did not share any markers or goal posts in its announcement. The fear, therefore, is that the moratorium will be renewed like the one instituted in 2013, she said.

“They have the tools, they have review choice, they’ve done the provisional period of enhanced oversight for hospices, they’ve been talking about AI and machine learning and algorithms that they’ve been using to better target and find these fraudulent actors,” Loeffler said. “We support those targeted approaches. Let’s deploy them. This moratorium worries us, because you have those tools already, you’ve deployed them already, and so what is it going to take to lift this moratorium? There’s no clear bar that CMS has provided publicly on what they want to see from us.”

The post ‘Makes No Sense’: Home Health Community Reacts To CMS’ Moratorium  appeared first on Home Health Care News.

The overall value of the deal was estimated at $1.1 billion when it was announced in February. At the time of the deal’s closing, each outstanding share of Enhabit common stock was converted into $13.80 per share in cash, and the stock was delisted from the New York Stock Exchange. 

“Today marks an exciting milestone for Enhabit as we officially begin our next chapter as a privately held company,” Barb Jacobsmeyer, president and CEO of Enhabit, said in a statement. “With Kinderhook’s support, Enhabit will benefit from additional resources and expertise that will enable growth, strengthen our clinical capabilities, and expand access to high‑quality care for patients, families and the communities we serve. I want to thank all of Enhabit’s employees for their dedication and for continuing to stay grounded in our mission and values to deliver extraordinary patient care.”

Dallas-based Enhabit operates 251 home health locations and 117 hospice locations across 35 states. Following the acquisition, it has become a wholly owned subsidiary and will continue operating under its existing name and brand.

Goldman Sachs & Co. LLC served as Enhabit’s exclusive financial advisor and Jones Day served as the company’s legal counsel. Guggenheim Securities, LLC served as Kinderhook’s exclusive financial advisor and Kirkland & Ellis LLP served as the firm’s legal counsel.

Kinderhook is a middle-market private equity firm that has raised over $11 billion of committed capital. It has made over 500 investments and follow-on acquisitions since being founded in 2003. Its investments include the health care, environmental and industrial services and light manufacturing and automotive industries.

“Enhabit’s leadership, patient‑centric culture and strong market position align closely with what we look for in a partner, and we are excited to help build on that foundation,” Chris Michalik, managing director at Kinderhook, said. “We look forward to working together so the Enhabit team can continue expanding access to care, elevating quality and delivering strong outcomes for patients and families.”

Home health has been a core focus for Kinderhook for decades, Michalik previously told Home Health Care News. 

“We believe deeply in [the home health/hospice] model, and our track record proves it,” Michalik told me. “The firm has successfully invested in and scaled multiple home health platforms by emphasizing clinical quality, patient experience and clinician engagement.”

Michalik also told HHCN that Kinderhook plans to support Enhabit through clinical quality initiatives, data and analytics capabilities growth and thoughtful market expansion.

The post Kinderhook Closes On Enhabit Acquisition appeared first on Home Health Care News.

The company’s M&A strategy – as well as its guidance and results – will feel “absolutely no impact, zero impact” from the recently announced Medicare enrollment moratoria for home health and hospice, CEO Jeff Shaner said. Still, the top executive said he was disappointed in the moratorium. 

“A nationwide moratorium is not the way to solve LA County’s specific, targeted fraud, waste and abuse, but I do think it’s consistent with the messaging that CMS has been sharing the last six months,” Shaner said on Aveanna’s first quarter earnings call. “The moratorium was thoughtful to not penalize current Medicare beneficiaries and current providers. But we would like, in these next six months, with the National Alliance of Care at Home, and all of our industry peers, to work with Dr. Oz and CMS to really target the areas where fraud, waste and abuse are occurring.”

While operationally irrelevant to Aveanna, the moratoria punish rural areas in need of increased health care access, Shaner continued.

Atlanta-based Aveanna Healthcare operates in 39 states, offering a range of pediatric and adult home-based services, including nursing, hospice and rehabilitation.

Aveanna expects its acquisition of Family First Homecare to close in late Q2. Following that deal, leadership plans to grow the company inorganically and organically. The company has some free cash flow that it could use for tuck-in acquisitions, but likely “nothing monumental.”

The company saw solid year-over-year growth in all three of its business segments, which Shaner attributed to the company focusing its clinical capacity on its preferred payers. The company aims to achieve eight private duty services preferred payer agreements in 2026, bringing the company’s total number of preferred payer agreements to 38. In Q1, Aveanna achieved four preferred payer agreements in this segment.

In home health, Aveanna expected to add five preferred payer agreements in 2026. In Q1, the company achieved four of these agreements, setting the company up to exceed its 2026 goals.

On the reimbursement side, Aveanna made progress with several of its rate improvement initiatives. The company expects to achieve mid-single-digit state rate enhancements in 2026. In the first quarter, Aveanna received three private duty services state rate wins. In private duty services, Shaner called the rate environment “very stable” and said the company is shifting its focus to cost-of-living and wage rate adjustments. 

In Q1, Aveanna’s revenue rang in at $647.9 million, a 15.9% year-over-year increase. Its adjusted EBITDA for Q1 was $84.4 million, a 25.2% increase year-over-year. It increased its full-year revenue guidance to between $2.56 and $2.58 billion.

The post Aveanna Expects ‘Zero Impact’ From Home Health Moratorium appeared first on Home Health Care News.

Yesterday, CMS announced six-month moratoria on home health and hospice Medicare enrollment. While there have been rumblings that CMS would take fairly drastic action to curb home health and hospice fraud, the moratorium represents a blunt instrument to do so. 

The moratoria apply to new home health and hospice agencies and new branch locations. It applies nationwide and can be extended in six-month increments. 

Not to let my pessimistic streak shine through, but based on CMS precedent, the industry might need to settle into this moratorium. It could be a while.

Under former President Barack Obama, CMS placed a moratorium on home health enrollment in 2013. It started in just a few counties in Florida and Illinois, but eventually expanded to all of Florida, Illinois, Michigan and Texas. It was continually extended in six-month increments and was in place for a total of 5.5 years.

The history demands that industry stakeholders adjust their strategies to find their new normal quickly. CMS’ decision has extensive practical and downstream implications. Home health providers must determine how their potential for growth is impacted, buyers need to carefully consider the potential for stalled or slowed deals and Medicaid providers are well-advised to consider this writing on the wall.

In this week’s exclusive, members-only HHCN+Update, I’ll dive into the home health moratorium, offering analysis and key takeaways, including:

– What this means for organic growth

– How M&A and investment will change

– The potentially looming Medicaid crossover

A hard stop to de novo growth

The enrollment freeze necessitates an immediate change in providers’ growth strategies. The moratorium takes one of the industry’s clearest growth pathways – opening new Medicare-certified locations – off the table. .

It’s key to emphasize that this moratorium does not just implicate startups or potential new entrants in the space. Existing and sophisticated operators will see their expansion options limited. In the words of the National Alliance for Care at Home (the Alliance), “an enrollment moratorium does not distinguish between bad actors and compliant providers.”

Providers can still operate, bill and maintain current enrollments while the moratorium persists, but this cuts off providers’ ability to grow by planting flags in new Medicare markets. Coming off of HHCN’s Capital+Strategy event, one of the key takeaways I walked away with was the importance of de novo growth. Experts described de novo growth as a version of “walk before you run,” so for providers that are not currently acquisitive, this shuts down a critical growth lever. 

The freeze to de novo growth does not limit all types of organic growth. This is where I think we’ll see the key shift happen in terms of growth strategies: Providers will transfer focus to increasing census within existing service areas, growing their referral networks, increasing clinician efficiency to serve more patients and other ways of increasing revenue at an existing location.

These methods are limited by several factors. Staffing shortages still persist; there are only so many ways providers can increase efficiency without shooting themselves in the foot; and clinicians may be reluctant to use any newfound windows of time to see as many patients as possible.

This shift also limits the potential for underserved areas to receive new attention. As usual, rural communities will fare worse under this new regulatory development. But all providers looking to grow need to strategize quickly to determine how best to address the enrollment freeze – especially since this moratorium may be far longer than six months.

Hurdles to acquisitive growth

So if a provider can’t grow their geography via de novo growth, how about M&A? It’s not prohibited under the moratorium. But the moratorium does make home health M&A more reputationally fraught, more operationally complex and potentially slower to close.

Stroke of the pen risk was a common talking point in 2025, given that CMS’ proposed home health Medicare base payment rate for 2026 featured the largest cut ever proposed. The moratorium represents an even stronger version of that risk. 

CMS framed the moratorium aggressively.

“The moratoria will allow CMS to temporarily halt the influx of new providers into these high-risk categories – a key source of fraudulent activity,” read a press release. 

CMS Administrator Dr. Mehmet Oz used phrases including “deeply troubling fraud,” “bad actors exploiting some of our most vulnerable Medicare patients,” and “stealing money from the American taxpayer” when referring to the home health industry as a whole.

There will be more news stories linking home health and fraud to come, and the language being used by government officials and the bad headlines will lead to more scrutiny from investors and more caution from buyers.

In response, operators and boards will have to move sensitively and prioritize compliance above all else. Additionally, currently in-flight transactions will probably take more time to close. Buyers and sellers should prepare for a lag from their expected run times.

New acquisitions will have to ensure they do not trigger the moratorium’s rules regarding certain changes in majority ownership. I reckon this will make deals more expensive, as buyers and sellers will likely increasingly engage outside experts. 

Between the extra compliance steps and the headline risk, the upward trend of home health M&A in 2026 is bound to suffer.

Medicaid concerns

The new moratorium affects only Medicare home health and hospice, but an FAQ released by CMS raises concerns for Medicaid home-based care providers.

I want to include CMS’ full answer to the question: “How will the moratorium affect Medicaid HHA and Hospice providers?”

“At this time, we believe it is in the best interest of Medicaid and CHIP beneficiaries across the country to allow each state to decide whether some form of a HHA and/or Hospice moratorium is appropriate for their respective Medicaid and CHIP programs, and the scope of any such moratorium. Each state has greater expertise and experience with their pool of providers, including their state requirements for HHAs and Hospices, than CMS. Nevertheless, CMS encourages each state to, as appropriate, implement a HHA and Hospice provider moratorium tailored to the specifics of their beneficiary population, as well as any geographic considerations. Additionally, CMS is offering every state and territory the opportunity to consult with CMS on the prospect of implementing a Medicaid-based, CHIP-based, or a Medicaid and CHIP-based HHA and/or Hospice moratorium in their jurisdictions.”

As you can see, CMS is directly encouraging states to consider a Medicaid home health and hospice provider moratorium. CMS could have simply stated that the Medicare moratorium does not apply to Medicaid and left it there. Providers not currently implicated in CMS’ new moratorium may want to buckle up.

It is worth noting that the 2013 Medicare HHA moratorium also applied to Medicaid in the affected states. That was not optional – states in the moratorium areas were required to comply unless they determined it would adversely affect beneficiary access. Now, CMS is changing its approach and leaving it to state discretion.

Given the second Trump administration’s focus on fraud, waste and abuse, I think it’s unlikely states will just ignore CMS’ call to consider moratoria of their own. Providers operating in states that the CMS has specifically flagged as hotbeds of Medicare fraud – California, Nevada, Arizona, etc. – should be especially wary. The political affiliation of a given state is also critical to consider.

The Medicare moratorium and the freeze on de novo growth are the headlines for existing home health providers. But the risks to M&A and increased oversight should be top of mind as well. And Medicaid providers can’t keep their eyes off the ball. States will be making some big decisions in the near future, and CMS just made it clear which way it thinks these decisions should go.

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Home Health Care News: What core experiences have shaped the way you view home-based care today?

Miki Kapoor: Several core experiences have shaped how I view home-based care today, but the theme has always been a mission-first focus on the people we serve. Throughout my career in public health, I’ve been driven by a belief that access to quality care, and strong outcomes should go hand in hand—and that systems can be both person-centered and financially responsible stewards of taxpayer dollars. 

Earlier in my career, I had the opportunity to work on global health initiatives across Africa and India, which were incredibly formative for me. I was doing work on the ground and leading a 1,000-person team for a large global nonprofit, all centered on expanding access for people facing serious, disabling and sometimes life-threatening diseases. My time in South Africa especially reinforced how much access to quality care shapes not just health outcomes, but a person’s ability to live with dignity.

That perspective has stayed with me ever since. It’s what drew me to PPL initially as a board member and ultimately into the CEO role. Home-based care, especially in a self-directed model, reflects those same principles: giving people more control, supporting them in their communities, and ensuring care is delivered in a way that’s both compassionate and accountable.

How do you define self-directed care? And what has held the model back from broader adoption across states and health systems?

Self-directed care challenges the traditional way we’ve thought about delivering care in this country. For years, the system has been built around costly institutions and large agencies, not individuals. Shifting that mindset takes time. Our healthcare system is still largely built around what I’d call large transactions for patients, while self-directed care centers on smaller but deeply meaningful home care interactions. That goes against the grain of how the broader system has traditionally operated.

Historically, one of the biggest barriers to broader adoption has been infrastructure. Earlier models often lacked the standardized systems, oversight, and technology needed to scale effectively, which made some states hesitant to expand. There was also a misconception that giving consumers more control would mean less accountability, when in reality, the opposite is true when the model is implemented correctly and with proper program controls overseen by a fiscal intermediary.

What’s changed is that we now have the necessary tools to support self-direction at scale and prevent fraud, waste and abuse. We have better technology, clearer program rules, stronger administrative support, and more real-time visibility into care delivery. That’s where PPL comes in. We provide technology, services, and support that help streamline every aspect of self-directed care. This allows people to live at home with dignity while hiring a family member or trusted loved one as a caregiver. That improves the participant experience, helps states manage these programs more effectively, and dramatically reduce expense for all constituents, especially taxpayers, in an accountable way. More states are starting to recognize that self-direction is not just a viable care model. It is essential to the future of fiscally sustainable and quality care and to the future of Medicaid.

With workforce shortages continuing to challenge traditional home care, how does the self-directed model change the dynamics of caregiver supply and retention?

The traditional agency and institutional model is struggling to keep up with demand. It relies on a very limited workforce, which has become harder and harder to sustain. Self-directed care changes that dynamic by expanding the workforce in a meaningful way. It recognizes and supports caregivers who are often already providing care, usually family members or close friends, and gives them compensation, structure, and access to benefits like healthcare coverage, sick leave and paid time off, while ensuring regulatory compliance to prevent fraud, waste and abuse.

That brings more people into the workforce while also improving retention. It creates the kind of flexibility many caregivers need but often cannot find in a traditional agency model. Just as importantly, it strengthens the relationship between the caregiver and the person receiving care. That consistency and trust lead to enhanced patient outcomes and a better experience on both sides, which is a major reason caregivers stay engaged over the long term. So in that sense, self-directed care is about more than just expanding workforce supply. It also improves outcomes, supports retention, and does so in an accountable way that prevents fraud, waste and abuse, and is more cost-efficient for states. That makes Medicaid stronger and more resilient over time.

One of the core features of self-direction is allowing consumers to hire family members or other trusted individuals. From your perspective, how does that reshape outcomes compared to agency-based care?

This is where care is going, because care is deeply personal. Outcomes improve when people feel comfortable, understood, and in control, and when they are cared for by a caregiver they know and trust. When individuals can remain in the place where they feel safest and choose caregivers they already know and trust, it fundamentally changes the dynamic.

You see stronger continuity of care, better communication, and support that is more aligned with a person’s cultural and personal preferences. It also reduces the friction that comes with rotating staff or unfamiliar providers, which is often part of the traditional agency-based model.

In many ways, self-direction formalizes what families have been doing all along, but adds structure, support, and fiscal] accountability. That combination leads to better well-being, a better care experience, reduced expense for the overburdened healthcare system and a higher quality of life for the person receiving care.

As more states look to scale self-directed programs, what are the key operational or policy guardrails needed to balance consumer choice with program integrity?

The key is recognizing that flexibility and accountability can coexist. It just takes the right foundation.

First, you need clear and consistent program rules that reinforce the consumer’s central role in directing and approving care. Second, strong oversight mechanisms such as electronic timekeeping, real-time data visibility, electronic caregiver visit verification, and standardized processes are critical for ensuring accuracy and preventing fraud, waste and abuse. Just as important are accessible training, multilingual resources and responsive customer service so both consumers and caregivers can navigate the program with confidence.

When those elements come together, self-direction can scale in a way that preserves choice while also strengthening transparency, compliance and long-term sustainability.

Looking ahead, do you see self-directed care remaining a complementary model? Or evolving into a central pillar of long-term care delivery in the United States? If it’s the latter, what will drive that shift?

There is no question in my mind, that self-directed care is evolving into a central pillar of long-term care. The demographic and workforce trends make that inevitable. We have a rapidly aging population and not nearly enough traditional caregivers to meet that demand. At the same time, people overwhelmingly want to receive care at home. They want to live with dignity and be supported by people they know and trust. Additionally, institutionalization will continue to drain our overburdened healthcare system.

Self-directed care directly addresses all of those realities. What will drive the shift is a combination of necessity and proof. As more states implement these programs successfully and demonstrate better outcomes, higher satisfaction and more efficient use of resources, it becomes clear that this is not just a quickly scaling model. It is a smarter way to deliver care. And we’re already seeing that recognition grow across the country.

In self-directed care, 2026 will be the year of…

Scale with accountability.

We’re moving beyond proving that self-directed care works. Now the focus is on showing that it can work at scale with the structure, transparency, and support needed to sustain it over the long term. That is when real transformation starts to happen, not just for individual programs, but for how care is delivered across the country.

What makes me optimistic is that we are already seeing that take shape. More people want to be cared for at home by people they know and trust, and states are increasingly recognizing the value of a model that can support dignity, choice, cost efficiency, outcomes and program integrity all at once. That is what 2026 is really going to be about.

Editor’s note: This interview has been edited for length and clarity.

To learn more about how self-directed care models are evolving and what it takes to implement them at scale, visit: https://hubs.ly/Q04cN9p-0.

The Voices Series is a sponsored content program featuring leading executives discussing trends, topics and more shaping their industry in a question-and-answer format. For more information on Voices, please contact sales@wtwhmedia.com.

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