The National Alliance for Care at Home (the Alliance) is the largest organization representing, advocating for and convening providers of home-based care, representing over 1,500 organizations and more than 10,000 agencies serving millions of people nationwide. The Alliance envisions an America where everyone has access to the highest-quality, person-centered care wherever they call home. We also recognize that advancing homecare and hospice is a critical strategic issue for policymakers who must address the needs of an aging population, driving health care and long-term care policy in a compassionate, high-quality and cost-effective direction.
The Medicare home health and hospice benefits, Medicaid home- and community-based services (HCBS) and other home-based models of care and palliative care in the home have seen incredible growth in recent decades. But this progress is at risk of stalling out at just the wrong time for our country, as short-sighted reimbursement policy proposals, misguided regulations and inadequate investments in workforce and innovation may prevent our country from realizing the full value of a vibrant and growing care-at-home sector.
I started my career as a family physician, focusing my practice on house calls for people who were too sick or disabled to leave their homes. I’ve seen firsthand the essential role of care at home, allowing providers insight into their patients’ lives that no other type of care provides, and enabling seamless integration of individuals into or back into their communities while still receiving the expert medical attention or social supports needed. I’ve been inspired by the individualized care and incredible teamwork that hospice providers bring to their communities—truly life-changing contributions that have impacted so many individuals and families while also creating great value for the system.
When Americans look for desirable solutions for the challenges of aging and chronic illness, our movement must be ready to support their needs. We’ve seen it before: During the COVID-19 pandemic, our members combined incredible skill, commitment and bravery to emerge as an essential frontline resource to secure our nation’s wellbeing. We know care at home is a big part of the solution, and now we must be prepared to meet the moment.
The Alliance and its members do this by engaging in critical advocacy work to ensure that the operating environment promotes access to care and positions providers to successfully deliver the highest-quality services to all who need them. This means a lot of things, but in short, providers must have adequate reimbursement to compete and hire talent, ensure regulatory and data compliance and deliver holistic care.
Last month, the Alliance convened more than 230 frontline providers and leaders in Washington to advocate for these priorities. While in over 300 meetings with members of Congress, advocates discussed four key issues: protecting home health care by preventing dangerous payment cuts, safeguarding the Medicare Hospice Benefit by ensuring that hospice remains a separate holistic managed care model outside of Medicare Advantage, supporting policies that promote robust Medicaid HCBS funding and expanding telehealth access across all of care at home.
Advocates shared the key issues impacting care, why it matters and what Congress should do about it.
1. Protect home health care.
The Centers for Medicare & Medicaid Services (CMS) is proposing a 9% cut to the Medicare Home Health payment rate, amounting to more than $1.1 billion in payment reductions for 2026 alone. The cuts are based on faulty calculations that do not follow the laws Congress previously developed to support home health.
These cuts would mean fewer home health agencies, longer wait times for patients during a critical period in their illness or recovery and the loss of vital care for seniors. Half of U.S. counties have lost home health agencies since 2020, and referrals already often go unfilled or delayed.
Advocates asked their representatives to strenuously oppose CMS’s proposed home health cuts and to support legislation—the Home Health Stabilization Act of 2025—that would pause the CMS cuts for two years to allow more time for holistic solutions.
2. Keep hospice out of Medicare Advantage.
Policymakers have been exploring “carving” hospice into Medicare Advantage (MA), meaning the MA plan would administer the hospice benefit instead of traditional Medicare.
This carve-in risks creating new barriers to care, delaying timely access, limiting patient choice and introducing administrative burdens. It would also threaten small or rural hospice providers, which would be less likely to have agreements with MA plans. Hospice is already managed care for patients at the end of life, and layering Medicare Advantage on top of the hospice benefit provides no value to patients and their families.
Advocates asked their representatives to oppose allowing Medicare Advantage plans to administer the Medicare Hospice Benefit.
3. Support Medicaid HCBS.
Chronic underfunding and waitlists mean over 700,000 people go without needed care each year, with some waiting years to receive support. Workers are paid low wages because agencies can’t fund higher compensation with the existing level of reimbursement.
Medicaid HCBS are cost-effective and help people stay in their homes, but low reimbursement hurts both worker retention and provider viability.
Advocates called on their representatives to support policies and funding to build more robust Medicaid HCBS programs and supports.
4. Expand access to telehealth.
Telehealth flexibility is increasingly essential to care delivery given advances in new technology. As of press time, allowing providers to supplement care with telehealth has yet to be permanently cemented into law. Losing these flexibilities, however, would disrupt access to care for seniors, especially in remote rural zones and high-traffic urban areas. It would also burden providers unnecessarily.
Advocates asked members of Congress to support legislation making telehealth flexibilities permanent, like the CONNECT Act (HR 4206 and S 1261).
Join Us
The Alliance’s robust grassroots and grasstops advocacy turnout is reflective of just how high the stakes are right now for care at home. Whether you’re a care-at-home provider, supporting vendor or just eager to be a part of the care-at-home movement, there’s a place for you to get involved in advocating for care at home.
Early in my career, I sought to deliver high-quality, compassionate care to those I visited in their homes. Now, through the Alliance, we’re working to multiply and formalize those efforts at the national level by representing and advocating for the rights of all current and future patients and families. Join me in bolstering the voice of our essential care at home movement by becoming an advocate today.