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Just weeks remain before the Centers for Medicare and Medicaid Services unveils the 2026 home health payment rule, which could mean massive payment cuts. The outpouring of public comments – over 952,000 – demonstrates the home-based care industry’s ability to rally together to advocate for the necessary resources to support and expand in-home services.
Just today, the National Alliance for Care at Home (the Alliance), along with over 150 patient, provider, community and advocacy organizations, penned a joint letter imploring congressional leaders to block the proposed 9% cut to the home health payment rate for 2026.
The home health industry historically hasn’t been one to passively sit back and accept changes that would negatively impact providers and the patients it serves, but its approach to advocacy has evolved dramatically over the years.
From the formation of the National Association for Home Care & Hospice (NAHC), now the Alliance, in the early 80s, to the efforts of individual home health companies over the years, the industry and its advocates have pushed the sector forward. However, with some of the most dangerous threats for the industry currently on the table, it’s clear that a significant amount of work remains to be done.
In my years reporting on home health, these advocacy efforts have led to everything from the introduction of various legislation to grassroots engagement, policy development and lobbying.
The growing emphasis on advocacy within the industry has also reshaped the leadership structures of major home-based care organizations, prompting the creation of new executive roles. Looking ahead, the next evolution of home health advocacy may even see industry leaders stepping directly into the policymaking arena to more actively shape the future of home-based care.
In this week’s exclusive, members-only HHCN+ Update, I’ll highlight how the industry’s approach to advocacy has evolved, and how advocacy has transformed the industry. I’ll offer key takeaways, including:
— How advocacy has sparked change and brought greater visibility to home health
— The value of government affairs and advocacy leaders at home health companies
— What else needs to happen to achieve continued progress
Advocacy efforts
While advocacy has been an industry-wide effort, Bill Dombi, senior counsel for Arnall Golden Gregory law firm and the former president of NAHC, has been one of home health’s fervent advocates.
We spoke recently, and he pointed out that the very existence of the Medicare home health benefit is the result of advocacy.
“Advocacy actually created the home health benefit in the 1965 program, as a last-minute addition, and that was led by a couple of members of Congress, prodded by people in the aging network to have it put in there,” he told me.
Some of the results of advocacy efforts that stand out the most to Dombi are the industry gaining the ability to have non-physician practitioners certify for Medicare home health eligibility and engage in the face-to-face encounter, as well as the inclusion of home health workers as essential workers during the COVID-19 pandemic. This led these workers to gain access to PPE, vaccines and more.
Home health advocacy isn’t solely driven by industry trade associations. While many industry professionals are part of these organizations, they are also pursuing advancements through company initiatives.
For example, Chico, California-based Butte Home Health and Hospice implemented a “Stop the Home Health Cuts Campaign.” The company’s clinicians and staff contacted local lawmakers to sway them from home health reimbursement cuts, as part of the initiative.
“Those tens of thousands of us represent millions of team members,” Robert Love, executive director of Butte Home Health and Hospice, said at a NAHC conference in 2023. “If we can engage them, tap into their voice, have them share with their networks, we’re going to go a lot further with our message.”
Aveanna Healthcare Holdings Inc. (Nasdaq: AVAH) is another example of a company that has a strong history of pushing for industry change.
“We’re very active in that advocacy front, and we are really increasing our grassroots advocacy efforts,” Jim Melancon, Aveanna’s senior vice president of government affairs, told me in August. “Internally, we just hired a director, and that will be her responsibility to help us. We have an advocacy connect network. It’s our internal platform that we use for grassroots efforts. We’ve really stepped up over the last few years.”
The Pennant Group (Nasdaq: PTNG) has a ‘Rule Response Team’ that is focused on helping the industry address the Centers for Medicare and Medicaid Services’ (CMS) rulemaking. The company beefed up these efforts as a response to the 2026 proposed payment rule.
“This time, we had to take a different approach,” Marisa Crecelius, deputy general counsel for Pennant, told HHCN in August. “It had to be about telling our story, not only to CMS, but to our legal representatives in Congress and in the Senate, and also our communities and our patients, so they can advocate as well. This has not only been coupled with a technical response to CMS, but also with social media campaigns.”
In my view, Bayada Home Health Care has become the model for how larger companies can deploy their resources and fully throw their weight behind advocacy. Hearts for Home Care — Bayada’s 501 (c)4 advocacy arm — has more than 350 trained ambassadors.
“We have one [ambassador] for every service office,” Dave Totaro told me earlier this month. “[They’re] trained in our issues and ready to mobilize their office team when we need them. No one else is doing anything similar to that.”
Totaro serves as Bayada’s chief government affairs, and president and executive director of Hearts for Home Care. He plans to retire from both roles at the end of 2025.
Nowadays, leadership roles dedicated to government affairs and advocacy are seen at most major home health companies, but Totatro was one of the first.
Dombi explained that creating a formal role on the leadership teams came from the recognition of the value of this approach.
“Large companies recognize that they operate on multi-state levels, and they want to have a voice in all of those states, as well as in the federal government side of it,” he said. “[There’s] the recognition that if you don’t advocate, then decisionmakers will be listening to somebody else and acting on behalf of somebody else. It’s not a squeaky wheel. You’re looking for something which is deafening, and sound is what you’re looking for with advocacy. That’s why we saw that multiplication of effort coming from grassroots and then from companies that adopted the government affairs officer approach.”
The rise of the role of government affairs executives demonstrates that the role of advocacy for home health has not diminished since the introduction of the Medicare home health benefit. The health care system increasingly has begun to operate in the home, but the resources for home-based care providers have eroded, making advocacy more necessary than ever. The consolidation of several advocacy organizations into the Alliance created one main industry voice, hopefully amplifying the needs of the industry. But the formation of the Alliance does not mark the end of the industry’s advocacy transformation. To spark the kind of sweeping transformation that came with the creation of the home health Medicare benefit, providers will need to embrace even more change.
Visibility and the future
Every advocacy win has amounted to greater visibility for the home health industry at large. The health care system overall is slowly becoming less hospital-centric, and home health is a major part of this.
“For many years, decades even, people looked at the continuum of care as a step down from a hospital to a skilled nursing facility to home care and so on,” Dombi told me during a previous HHCN interview. “Now, the breadth of care at home is greater than it’s ever been, with hospital-level care at home, with skilled nursing facility-level care at home, etc. When we look at how this happened, there’s no one person or one party that can be credited. It was clearly an effort from a multitude of people.”
On the M&A side, I’ve seen greater visibility lead to some of the industry’s biggest deals. Major health insurers have taken note of increased demand for home-based care and acquired in-home care providers, for example, insurance giant UnitedHealth Group (NYSE: UNH) acquired LHC Group and Amedisys.
Awareness for home health has also grown among Congress, regulators and state legislatures. Some lawmakers have even become champions of the industry; Sens. Debbie Stabenow (D-Mich.) and Susan Collins (R-Maine) come to mind, among others.
As a reporter in this space, I’ve also seen more health care-focused news coverage center on home health than ever before. Dombi cited one especially notable example.
“We did an analysis on how many miles are driven by caregivers in home care, and it found its way into the AP wire and ended up in local television station follow-up broadcasts, as national newspapers and the national news,” Dombi said. “That kind of advocacy itself helped raise the awareness of it, too.”
Despite the advocacy wins and the visibility that have since come, there is more that can be done to keep this momentum going.
Dombi encouraged more providers to tap into their networks to increase attendance at marches and rallies.
“The Alliance had its march on Washington, and the state associations as well, but the actual turnout for those is far short of what it could or should be,” he said.
While it’s common to see chief government affairs officers and similarly titled positions at the larger home health companies, I believe that some of the smaller companies should establish teams that are also dedicated to advocacy in some form.
When I asked Dombi what else could be done, he suggested that home health leaders step up and run for elected office.
“We’ve had a number of home care executives get elected to Congress or state legislators, and I think we could do more of that,” he said.
Ultimately, home health would not have reached its current point without advocacy.
“I don’t think this is overstating it,” Dombi said. “In the absence of advocacy from people from the aging and disability community, combined with the health care community, we wouldn’t have health care at home.”
The industry also can’t advance its next chapter without continued and revitalized advocacy efforts. Without fighting back against potentially handcuffing rate cuts, or immigration policies that are further exacerbating staffing challenges, the momentum behind the shift of health care into the home could fizzle out.
