By Alex Crews, client relationship manager, Senior Care Marketing Max
A report by CareVoyant, which offers intake, scheduling, authorization management, clinical, financial and business intelligence solutions to the home care market, highlights a number of Medicaid changes in 2025 that will have an impact on home care agencies.
The authors of the report note that home care agencies must adjust their revenue management practices to align with the 80/20 rule, ensuring that at least 80% of Medicaid payments go directly toward compensating care workers.
Establishing a dependable reporting system is crucial to maintaining compliance and avoiding penalties. Agencies accepting Medicaid would benefit from taking proactive steps now to meet these compliance standards, safeguarding their revenue streams and reinforcing the financial stability needed to support quality care delivery.
The report also notes that there will be enhanced oversight “with the goal of preventing states from using Medicaid funds to subsidize healthcare for ineligible individuals,” which is a top priority for regulators.
CareVoyant also flagged a number of other proposals, which could be revised before reforms are signed into law in 2026. They include:
- By 2026, able-bodied adults would be required to complete 80 hours per month of volunteering, and/or attending school to maintain Medicaid eligibility Certain exemptions would be available.
- The bill proposes to pause implementation of some rules meant to streamline enrollment. It also aims to enhance verification standards by requiring address and documentation verification for enrollment.
- Increasing the frequency of eligibility determination, which would require states to reverify Medicaid eligibility every six months, instead of once per year.
- A moratorium and limits on provider taxes would freeze provider taxes that have been implemented by some states to increase revenue for Medicaid. Limits would restrict how provider taxes can be used to finance Medicaid.
The report offers suggestions to navigate potential changes, including investing in the right software for home care agency management.
