In the evolving landscape of U.S. healthcare, home health and hospice services have emerged as indispensable pillars, providing millions of Americans with the opportunity to receive compassionate, high-quality care in the familiarity of their own homes. As the population ages and chronic illnesses become more prevalent, these services are not just a preference but a necessity for many, especially seniors and those with long-term health challenges. Yet, despite their proven value, the sector stands at a precarious crossroads, threatened by proposed payment reductions, regulatory overhauls, and persistent workforce shortages. Advocacy, spearheaded by entities like the National Alliance for Care at Home (the Alliance), has never been more essential to safeguard access to these vital services. The urgency stems from a stark reality: without immediate policy intervention, the ability to deliver person-centered care at home could be severely compromised, leaving vulnerable populations at risk.
The Personal Value of Care at Home
Home health and hospice care transcend mere medical treatment, offering a deeply personal approach that allows providers to gain unique insights into patients’ daily lives and environments. This intimate perspective enables tailored interventions that address not only physical health but also emotional and social needs, fostering a sense of community and belonging. Particularly in hospice settings, the emphasis on dignity and comfort during end-of-life care creates profound impacts for patients and families alike. Such personalized care stands as a testament to the sector’s role in enhancing quality of life, distinguishing it from more institutionalized alternatives. The ability to build trust and deliver support in a familiar setting often results in better health outcomes and greater patient satisfaction, underscoring why this model is so cherished by those who rely on it.
Protecting this human-centered approach through advocacy is paramount, as the resources and policies needed to sustain it are under threat. If supportive measures are not enacted, the capacity to offer such individualized attention could erode, disproportionately affecting those who depend on home-based services the most. Seniors, individuals with chronic conditions, and rural residents face the greatest risk of losing access to care that meets their specific circumstances. Advocacy efforts must focus on ensuring that providers are equipped to maintain this level of service, highlighting the broader societal value of keeping care rooted in the home environment. The push for legislative support is not just about funding but about preserving a model that prioritizes humanity over mere efficiency.
Navigating Financial and Regulatory Threats
Among the most immediate challenges facing the home health sector is a proposed 9% cut to Medicare Home Health payment rates by the Centers for Medicare & Medicaid Services (CMS), amounting to over $1.1 billion in reductions for 2026. These cuts, rooted in questionable methodologies, disregard existing legal frameworks designed to support home health services. The consequences are already evident, with half of U.S. counties experiencing provider losses in recent years, leading to extended wait times and unfulfilled referrals for critical care. Advocacy to counter these reductions, including backing for the Home Health Stabilization Act, is crucial to prevent further erosion of access. Without intervention, the ability to meet growing demand, especially among an aging population, will be severely hampered, leaving many without timely support during recovery or illness.
Another looming regulatory concern is the potential shift of the Medicare Hospice Benefit into Medicare Advantage plans, a move that could disrupt the current standalone structure. Such a change risks erecting barriers to care, restricting patient options, and imposing additional administrative burdens on providers, particularly smaller and rural agencies that may struggle to adapt. The existing hospice model is already designed as a managed care framework tailored for end-of-life needs, rendering integration into broader plans unnecessary and potentially harmful. Advocates are pressing Congress to reject this policy, emphasizing that maintaining the independent nature of the benefit is vital for preserving quality and choice. The unified stance among stakeholders reflects a deep concern that without protective measures, the essence of hospice care could be undermined at a time when it is most needed.
Tackling Funding Shortfalls and Access Barriers
Medicaid Home- and Community-Based Services (HCBS) are grappling with persistent underfunding, a crisis that leaves over 700,000 individuals languishing on waitlists, often for years, without access to essential care. Insufficient reimbursement rates exacerbate the issue, making it challenging for agencies to offer competitive wages and retain skilled staff, which in turn fuels high turnover and workforce shortages. HCBS represent a cost-effective alternative to institutional care, enabling people to remain in their homes and communities, yet their viability is at stake without significant policy reform. Advocacy for enhanced funding and legislative support is critical to bolster these programs, ensuring they can meet the needs of diverse populations. Addressing this gap is not just about numbers but about equity, as many on waitlists are among the most vulnerable in society.
Equally pressing is the need to secure permanent telehealth flexibilities, which have become a cornerstone of modern care delivery, especially for reaching patients in remote rural areas or congested urban centers. Temporary provisions currently in place risk expiring, threatening to disrupt access for seniors and impose unnecessary operational challenges on providers. Telehealth has proven its worth in expanding reach and improving efficiency, making its integration into long-term care models non-negotiable. Legislation like the CONNECT Act is a focal point for advocates, who argue that codifying these capabilities into law is essential for equitable service delivery. The push to make telehealth a permanent fixture reflects a broader recognition that innovation must be supported alongside traditional care to address the evolving demands of the healthcare landscape.
Building a Sustainable Future Through Collective Action
The rising acknowledgment of home-based care as a fundamental element of a sustainable healthcare system drives the call for robust advocacy across all levels of policymaking. Demographic trends, with an aging population and increasing chronic illness rates, amplify the demand for services that allow individuals to age in place with dignity. Stakeholders, including providers, leaders, and community advocates, share a consensus that policies must adapt to provide sufficient funding, clear regulations, and avenues for innovation. The Alliance’s recent initiative in Washington, D.C., where over 230 frontline providers engaged with Congress in hundreds of meetings, exemplifies the collective determination to confront these challenges. Such efforts highlight the need for a unified front to ensure that home health and hospice services remain accessible and effective in meeting societal needs.
Beyond immediate policy battles, advocacy serves as a catalyst for long-term systemic change, pushing for a healthcare framework that prioritizes care at home as a cost-effective and compassionate solution. The interconnected nature of current challenges—be it funding cuts, regulatory shifts, or access barriers—demands a holistic approach that addresses both existing threats and future growth. Supporting initiatives that attract and retain talent, streamline compliance, and integrate technology like telehealth are all part of this vision. The commitment shown by thousands of agencies under the Alliance’s banner signals a readiness to adapt and innovate, provided the right legislative environment is in place. Protecting this sector means safeguarding a model of care that aligns with the values of independence and personal well-being for millions of Americans.
Shaping Tomorrow’s Care Landscape
Reflecting on the strides made in home health and hospice advocacy, it becomes clear that the efforts of countless providers and leaders have laid a critical foundation for addressing systemic challenges. The meetings in Washington, D.C., have not only amplified the voices of those on the frontlines but also forged vital connections with policymakers who can influence change. Each discussion held with Congress has underscored the gravity of payment cuts, regulatory threats, and access gaps, driving home the human cost of inaction. The resolve to protect Medicare benefits, strengthen Medicaid programs, and secure telehealth advancements has resonated across diverse stakeholders, creating a shared sense of purpose.
Looking ahead, the path forward demands sustained collaboration and strategic action to build on these advocacy gains. Prioritizing legislative support for initiatives like the Home Health Stabilization Act and the CONNECT Act could offer immediate relief while paving the way for broader reforms. Encouraging investment in workforce development and technology integration stands as actionable steps to enhance service delivery. Ultimately, ensuring that every individual can access high-quality care at home requires a commitment to evolving policies that match the sector’s growing importance, setting a precedent for a more inclusive and responsive healthcare system.
