Better Information Crucial To Improved Home Health Reimbursement

Slashed Medicare rates are the most significant headwind pummeling home health providers in 2025.

This two-fisted conundrum includes both actual Medicare fee-for-service rate cuts as well as the historically lower rates favored by Medicare Advantage plans. As MA becomes more prevalent in health care, those lower rates contribute to revenue attrition that threaten long-term sustainability.

This issue goes beneath the surface and into the data that the U.S. Centers for Medicare & Medicaid Services (CMS) uses in part to calculate payment rates. Cost reports submitted to the agency, for example, do not include Medicare Advantage data, David Jackson, CEO of Choice Health at Home, told Home Health Care News at the HomeCare 100 conference in Marco Island, Florida.

“We’re only cost reporting on our traditional Medicare, so the visibility to the financial ramifications on the agencies is not even being front line to Congress,” Jackson said. “Whenever the [Medicare Payment Advisory Commission (MedPAC) stands up and says, there’s this Medicare margin — and 50% of the population is on Medicare Advantage — and you see the issues that are happening.”

In health care in 2025, data rules, and the numbers that are guiding some payment decisions are both incomplete and directly tied to the care of the Medicare beneficiaries enrolled in MA, about half of the total population. This creates a broad blind spot in the payment models that fuel U.S. health care.

MA plans saw a 0.16% decrease to core payments in 2025, a second-straight adverse rate update, and yet they oversee the care of 33.4 million people in the United States. Such an environment does not make higher payments to providers very likely in the near term, and some home health companies have already abandoned certain MA contracts because they were financially unsustainable.

This is not to say that merely throwing money at Medicare Advantage is the solution. Nor are payment rates the program’s only gadfly. MA has been fraught with controversy over prior authorizations, denials of care and other issues that directly impact both patients and providers.

But through whichever mechanism home health providers are paid, these should be supported by complete and accurate data that paint a more realistic picture of reimbursement stability in the sector.

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