26 Things Care at Home Leaders Need to Know in 2026

2026 opened with an unexpected shift for home health providers. The Centers for Medicare & Medicaid Services (CMS) scaled back its proposed $1.1 billion payment reduction after industry pushback, lowering the final impact to about $220 million. While the change reduced the severity of the cut, home health still entered 2026 facing continued reimbursement pressure.

Meanwhile, hospice now accounts for more than $30 billion in annual Medicare spend and is under increasing scrutiny. And for the first time in years, Medicare Advantage growth may be plateauing, raising new questions about what comes next.

Taken together, these signals point to something bigger: the care-at-home landscape is shifting.

In January, I sat down with Dr. Steve Landers, former CEO of the National Alliance for Care at Home, to unpack what’s changing in 2026 and what leaders should be preparing for now.

Here are 26 insights already reshaping care at home in 2026:

Policy & Reimbursement

1. The Home Health “Permanent Adjustment” Era May Be Ending
After years of budget neutrality pressure, the 2026 final rule showed a dramatic policy reversal from the proposal, potentially signaling the end of continuous downward adjustments.

2. Hospice Spending Crossing $30 Billion in 2026 — And That Makes It a Target
Medicare hospice payments are expected to exceed $30 billion in 2026, making program integrity and demonstrating quality more critical than ever.

3. Declining Visits Are a Policy Signal
Fewer visits, more non-admits and agency closures aren’t just trends; they’re indicators that reimbursement pressure is impacting access. When regulators see expanding Medicare deserts, it strengthens the case for rate relief, but it could also lead to new access mandates that force agencies to accept unprofitable patients.

Regulatory & Compliance

4. CMS Is Watching Long Length of Stay Closely
When more than 60% of spending goes to patients with stays over 180 days, CMS is sharpening its focus on clinical appropriateness. End-Stage Renal Disease and cancer length of stay (LOS) patterns are particular areas of review so clear, defensible documentation is essential.

5. Non‑Hospice Spending Is on CMS’ Radar (Especially Skin Substitutes)
CMS is monitoring reports on rising non‑hospice Part B spending for enrolled hospice patients, often tied to high‑cost wound products. Overuse may trigger audits.

6. Fraud Oversight Will Be More Targeted — and Less Forgiving
CMS is moving toward risk-based algorithms and geographic targeting rather than broad audits — but compliant providers must prove they belong in the “low-risk” category.

Medicare Advantage Challenges

7. Medicare Advantage Penetration May Be Shifting
After years of Medicare Advantage (MA) growth, projections show potential decline. Q1 results will clarify whether this is temporary or a structural shift. Either way, payer mix strategies may need recalibration.

8. The Hospice "Carve-In" Debate Intensifies
If MA plans gain direct control over hospice benefits instead of using traditional Medicare, it fundamentally reshapes contracting, care models and the hospice business structure.

9. MA Administrative Burden Requires Proactive Strategy
Prior authorizations, documentation requirements and rate pressures aren't going away. Agencies need deliberate strategies to negotiate better rates and terms and streamline processes.

10. Supplemental Benefits Are Reshaping Home Care Markets
MA plans are increasingly offering supplemental home care benefits, creating new market opportunities but also new competitors and alternative pathways to patients.

Workforce & Operations

11. Access Deserts Are Expanding
Agency closures are creating geographic gaps in coverage, particularly in rural areas. This means access to care issues and risk of hospitalization without access to care in the home.

12. Delays and Non-Admits Are Rising
When patients can't access timely home health, they end up in hospitals or without care entirely. This affects outcomes, costs and community reputation.

13. Rates Still Aren’t Keeping up With Labor Inflation
Market basket updates haven’t matched wage growth, making clinician recruitment and retention increasingly challenging.

14. Providers Are Competing With Hospitals Again
Without reimbursement parity, home-based care risks losing clinicians back to inpatient settings.

Quality & Measurement

15. Hospice Quality Metrics Remain Strong
Despite all the pressure, hospice is delivering high-quality care. These metrics demonstrate value to payers, regulators and communities.

16. HOPE Is More Than an Assessment Tool
The Hospice Outcomes & Patient Evaluation tool is laying groundwork for future payment, benchmarking or accountability models.

17. Live Discharges Are Becoming a Risk Indicator
CMS and MedPAC view live discharge rates as indicators of appropriate hospice admission and quality, so it's worth monitoring your own trends.

18. Quality Measures Aren’t Ready to Carry Payment Risk
Without proper risk adjustment, tying payment to quality could penalize providers serving higher-need or socioeconomically vulnerable populations.

Market Forecast

19. The 85+ Population Doubles in 14 Years
The 85+ population will double by 2040 and triple by 2060, making home-based care capacity a national necessity, not an alternative. The question is whether your infrastructure, workforce and capacity can scale to meet it. Providers must assess readiness to scale.

20. Nearly Half of U.S. Counties Have More Seniors Than Children
Demographics are reshaping local markets faster than reimbursement models are adapting. Communities are fundamentally shifting toward elder populations, changing everything from workforce availability to local resource allocation.

21. 8 Million People Rely on Medicaid Home Care
Pressures and uncertain outcomes tied to the One Big Beautiful Bill Act's impact on state budgets, combined with states already freezing or cutting rates, risk widening the access-to-care gap and intensifying the strategic tension between mission and margin.

22. Private Pay Markets Are Growing
With hourly rates in the $33-34 range, private pay is becoming a viable revenue stream as families increasingly pay for informal caregiving support.

23. Palliative Care Models Present Both Opportunity and Competition
Palliative care can expand your continuum or create competitors who capture patients before they reach hospice-appropriate status.

Advocacy & Leadership Imperatives

24. Grassroots Advocacy Matters More Than D.C. Lobbying
Direct local engagement with congressional offices, especially through patient stories, has outsized influence compared to national advocacy alone. Engage and invite them to hear and see your community impact. Let your voice be heard.

25. This Is the Time to Build Policy Relationships
Early 2026 offers a rare window without urgent legislative battles. Use it to introduce yourself to representatives and build rapport before the next crisis.

26. Industry Participation Powers Change
Policy change requires collective action. Whether through associations, coalitions or direct engagement, your participation shapes the regulatory environment you'll operate in. We are stronger together.