How The Incoming Trump Administration Could Impact Home-based Care

Questions always abound when a new presidential administration comes in, but Republicans’ focus on cost-cutting hold potential for home-based care — if providers can advocate for themselves in Washington. 

Though uncertainties abound when it comes to the Trump administration’s approach to health care, many notable policies have been implemented during Republican administrations. From the establishment of the Medicare Hospice Benefit under Ronald Reagan to the unveiling of Programs for All-Inclusive Care of the Elderly (PACE) under the first Bush administration, this track record can be source of optimism, according to Edo Banach, partner at Manatt Health, a division of the law firm Manatt, Phelps & Phillips, LLP.

“The optimistic note is that a lot of the positive things that have happened in health care over the last 30 years have happened under a Republican Congress, a Republican administration or both,” Banach told Home Health Care News. “I think we’re going to see an increase in opportunities when it comes to caring for vulnerable folks, people who have Medicare and Medicaid, people who are chronically and seriously ill. If the incoming administration wants to solve an economic problem, they can’t solve an economic problem without solving that problem. You’re not going to save money if you simply cut services, so you have to be smarter about the way that you deploy those services.”

Banach previously served as deputy director and senior leader at the U.S. Centers for Medicare & Medicaid Services (CMS) during the Obama administration.

A key component of this is the Republican drive to cut costs, particularly as it pertains to the Medicare trust fund. Home-based care has a proven track record of reducing the total cost of care, which could lead to increased government investment in those services.

Hospice is a great example. Hospice care saves Medicare roughly $3.5 billion for patients in their last year of life, according to a joint report from the National Alliance for Care at Home and NORC at the University of Chicago.

Likewise, participants in the home health value-based purchasing model (HHVBP) have saved Medicare more than $1.38 billion over six years in nine states, according to CMS.

The same principle extends to palliative care. Home-based palliative care could reduce societal health care costs by $103 billion within the next 20 years, the nonprofit economic research group Florida TaxWatch said in a 2019 report.

“With just sheer alignment in the House and Senate and the executive office, I hope it provides an opportunity to get some real, meaningful things done that are beneficial for the country,” Nick Westfall, chairman and CEO of VITAS Healthcare, told Home Health Care News. “The new administration creates a bit of an opportunity for this space with some of their stated goals to look for opportunities to make the governmental programs more efficient and save taxpayers money. Hospice is part of that solution for health care.”

VITAS Healthcare is a subsidiary of Chemed Corp. (NYSE: CHE).

A key question is the future of Medicare Advantage, a program which has come under increasing scrutiny in the past year, particularly due to reported claims denials and delays in care related to administrative processes, among other concerns.

Nevertheless, MA has been a rising tide in home health, in particular. Also, hospices have sought MA contracts to support expanded business lines like palliative care and other services. This stands to reason in light of massive growth in the Medicare Advantage population.

In 2024, more than 33 million beneficiaries were enrolled in MA, about half of the entire Medicare population, CMS reported. This is up from 19% in 2007.

“Everyone is watching to see if the new administration will be a stronger advocate for expanding Medicare Advantage’s management of Medicare dollars, including a wholesale carve-in of the hospice benefit,” Alivia Care CEO Susan Ponder-Stansel told Home Health Care News. “Much depends on how quickly and effectively the new administration’s agenda in HHS and CMS can be implemented, but most of us who are paying attention expect to see a continued expansion of MA enrollment, and with that more pressure to get rid of the carve-out.”

Regardless of where the new administration goes, advocacy by and for home-based care providers will be crucial, according to Dr. Steven Landers, CEO of the National Alliance for Care at Home.

Among the key issues to be addressed, in addition to expanding access to care, is fixing reported flaws in the implementation of initiatives like the hospice Special Focus Program and the Patient-Driven Groupings Model for home health, Landers said. Home health reimbursement cuts are also a key concern.

“So much of what we’re fighting about and concerned about as an industry is about how [the U.S. Department of Health and Human Services], or CMS is implementing the laws that are already passed,” Landers said at the Home Care 100 conference in Marco Island, Florida. “So we’ve got this new day. We have this moment. We’re gonna have a new secretary. We’re gonna have a new [CMS] administrator. There are new policy advisors in the White House, some new folks in the [Office of Management and Budget]. We have to prioritize going and building these relationships, and giving them the information, the data, on how some of these implementations have gone wrong.”

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