Bayada Nonprofit Executive Director On The At-home Care Medicaid Squeeze, Industry Consolidation

The home-based care industry is being squeezed on all fronts when it comes to state Medicaid reimbursement, leaving providers struggling to sustain competitive wages and navigate a host of financial challenges.

That’s according to Sue Chapman Moss, the new executive director of Hearts for Home Care and Bayada Home Health Care’s senior vice president of payer strategy and government affairs. An increased focus on program integrity – eliminating fraud, waste and abuse – is necessary to improve the home-based care industry’s reimbursement status quo, Moss told Home Health Care News.

Bayada provides home health, home care, hospice and behavioral health care services in 23 states and six countries. Hearts for Home Care is Bayada’s 501 (c)4 advocacy arm. Moss took the role of executive director at Hearts for Home Care following the retirement of Dave Totaro, who also served as Bayada’s chief government affairs officer.

Moss sat down with HHCN to discuss the state of play for home-based care reimbursement, consolidation within the industry and Hearts for Home Care’s key goals in 2026.

This interview has been edited for length and clarity.

HHCN: The One Big Beautiful Bill Act (OBBA) dominated conversations about Medicaid reimbursement in 2025. What is the actual status of reimbursement for home care, given all that changed in 2025?

Moss: I would definitely say we’re seeing impact from the One Big Beautiful Bill. At the state level, states are seeing a larger budget deficit than ever before. States are using a portion of their federal match, and the offset is not available with tax revenue dollars and other sources of funding within the state. That’s on the public side.

On the private side, we are also seeing very, very similar in our managed care payer conversations. We are seeing that managed care plans, particularly the Medicaid managed care plans, are also struggling with the economics of providing services to beneficiaries post HR-1.

There are really only three levers that you can pull in a managed in a Medicaid program. Number one, the number of people who are enrolled. Number two, the rates that are paid to providers. And, number three, the benefit that you offer, whether it’s the benefit coverage, so the number of hours of services, for example, in home care. And we’re seeing all three of those, enrollment rate reduction and downward pressure on utilization, happen in all states.

And where does that leave providers?

The way we see it is, running a home-based care organization requires that we maintain competitive wages. So the real pressure point or bottleneck is when price inflation is lower than wage inflation. So some of the things that we’re doing [are], we are focused on the most efficient and effective ways to deliver care. Some of the programs that we’ve invested in are specifically targeted on enhanced quality of care so that we’re creating more value for the end user, whether that’s a government-funded program, a managed care plan, or the individual clients we serve and the caregivers.

What needs to change for and on the Medicaid side, for this state of play to improve?

Some of the things that we see as opportunities align with much of the conversation that we see going on in the public domain around investing in the high-quality providers and services and ensuring that every Medicaid dollar is used for its highest and best use, by eliminating fraud, waste and abuse. We are really leaning into being an exceptionally compliant and high-quality provider, and I think that’s really an exciting opportunity as we think about making the Medicaid program more sustainable, and also focusing on program integrity.

What are your recommendations for providers coping with Medicare reimbursement uncertainty?

Payer diversification, revenue diversification, is one of the levers that is certainly recommended in this situation. Always focusing on being a good steward of the healthcare dollar requires an ever-present focus on efficiency and effectiveness.

I certainly think there will likely be some level of industry consolidation. We saw in the headlines [recently] that Enhabit, one of our fellow providers in this space, is being acquired by a private equity firm. So I think there are a lot of different approaches that providers can take. There is no one single tactic at this point to be able to grow and thrive, and it requires all revenue, all expense tactics and growth as well.

What’s top of mind for Hearts for Home Care in 2026?

Top of mind for us in the home-based care industry is the need has never been greater, and the challenges have never been as significant.

I would definitely say the growth potential for care in the home is quite significant. The demand is there and growing. The challenges are also equally important to think about. Number one [is] workforce availability – certainly making sure that we are making the right investments in this being an attractive and fulfilling career for people who are going through training in nursing school, for example.

The second [challenge] is the financing of care in the home. The challenge is that as a society, we are spending a large portion of our economy and healthcare already and at the same time recognizing that where those dollars are spent are not getting us the best outcome. So we would like to see a greater portion of healthcare dollars invested in care in the home, and we’ve really been focused with our federal and state associations on improving rates and moving towards value-based payment models.

What are Hearts for Home Care’s key advocacy goals for 2026?

Our key advocacy goals are to ensure stable and funding for Medicaid with a high degree of focus on program integrity. That is our primary goal in all of the states from a sustainability perspective. That’s looking at rate increases that match the wage pressures that we are feeling, while at the same time ensuring a high degree of compliance with program integrity requirements. So that’s been our focus for state-level Medicaid funding.

At the federal level for Medicare, we at Hearts for Home Care are highly aligned with the National Alliance for Care at Home and HCAOA, the two major trade organizations that we are part of. Those focuses will be on reversing the trend on these Medicare fee-for-service cuts, number one, ensuring that hospice remains the great program that it is and doesn’t suffer from a transition into, potentially, into Medicare Advantage, which has been something that the Slliance has been focused on. Then for HCAOA, we support their goals as well. Those goals, including the program sustainability and integrity that I mentioned, are our big priorities. We are focused across a multitude of service lines. I think that’s what makes Hearts for Home Care unique in its grassroots efforts.

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