VA Cuts Harm Another Provider

by Kristin Rowan | Jul 24, 2026 | Advocacy, Veterans Affairs

by Kristin Rowan, Editor

Veterans Losing Access to Care

The 90-year-old veteran clutched tightly to his medal, a Purple Heart, as he made his way to a VA health center to apply for care. That was nine months ago.

He is still waiting.

Franchise Executive Speaks Out

We spoke with Heidi Maddocks, VP of Health Care Strategies and National Alliance for Amada Senior Care, a national franchise system with franchisees in Texas and New Mexico. She describes herself as a “self-appointed veteran advocate.”

“The rate cuts for Texas and New Mexico don’t make any sense,” she told us. “The community care network was created for veterans to access care outside of VA facilities. The parts they cut hit hardest where it is already hard to get care, such as rural areas in both states.”

She added...

“This is only one of many issues we have with the VA, but that is a story for another day.”

“Who decided this? What data did they use? Why did they keep rates steady in every other state?” She has a lot of questions, but found that the VA does not answer such questions. Perhaps that would change if more agency owners spoke up.

Veterans Experience Office

Maddocks works closely with the Veterans Experience Office in DC but is disappointed to find that most veterans do not know it exists. “Personnel in their regional offices are trying to do better,” she said. “They are not responsible for the cuts but must try to increase awareness and enrollment in spite of them. 48% of veterans are not enrolled in VA healthcare, often because they are elderly do don’t know it is available to them.”

A mission of awareness

Enrolling veterans is one of her missions. “It is one of three pain points for veterans,” she continued. “Suicide and homelessness are the other two. All three accompany loneliness.” Even veterans who receive other benefits don’t know about healthcare benefits they may be entitled to because the VA Health Administration and the benefits side are siloed. “They don’t talk to each other,” she asserted.

Veterans' Needs Come First

Ms. Maddocks understands that the VA Administration is trying to manage their budget. She does not know why Secretary Doug Collins can not understand that cutting home care will not achieve that goal. Limiting in-home services has always led to higher total expenditures when patients and clients are forced into institutional care.

“We have to put the veterans first,” she emphasized. “That is why we have kept our Waco office open, for example, even though it is operating at a loss. We have to have caregivers drive in from Dallas, which means higher hourly rates and drive time reimbursement.

Peer Advocates

She has also compiled a list of zip codes where veterans are impacted, in order to facilitate planning for resource allocation.

Final Thoughts

As we quoted in the first of these reports, VA Secretary Doug Collins believes his cuts will merely bring these two states in line with national market rates. He said they will not impact veteran care. The experience of Amada and other agencies to which we have spoken proves him wrong.

The thought of veterans, especially rural veterans, losing their in home care is devastating. For some, this is the only human contact they have. For others, it is the only contact they can have. The consistency and familiarity that comes from having the same caregiver visit at the same time in a familiar setting is vital for veterans with PTSD or dementia. Disturbing that care and then claiming the rate change will not impact veteran care is ignorant and irresponsible. Whether you are operating in Texas and New Mexico or not, please consider writing to Secretary Collins and your local officials to ensure someone with decision-making authority is looking at the reality they have created.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

VA in NM: An Interview from a Provider

by Kristin Rowan | Jun 19, 2026 | Advocacy, Veterans Affairs

by Kristin Rowan, Editor

VA in NM

An Inside Look from an Anonymous Provider

Effective January 1, 2026, the U.S. Department of Veterans Affairs made substantial rate cuts that impacted hundreds of veterans. None moreso than in rural areas of Texas and New Mexico. Reports from national and local news and associations reported a 43% rate cut in rural Texas and a 20% rate cut in rural New Mexico. On paper, those numbers are accurate. In practice, the situation looks much different. The Rowan Report spoke with a provider in New Mexico who asked to remain anonymous to preserve their relationship with both the U.S. VA and their local VA office.

Background and Experience

This anonymous source has worked in the home care space for 10 years. They opened the agency they now own about 3 years ago. The provider agency is strictly non-medical home care, operates in seven states, including their largest location in New Mexico, and has a patient population that is 90% VA.

What's Really Happening with VA in NM

Prior to the rate change, the home health aide (HHA) in New Mexico was $67 per hour. The new HHA rate for 2026 is $54 per hour. The source says if it were just the rate change, they could survive. But, the rate change is only one change impacting the agency.

HHA vs Homemaker

Prior to 2026, the average veteran received set hours of care almost exclusively at the HHA rate of $67 per hour. The rate change in New Mexico also include a split authorization requirement, capping the HHA hours at 60% of the total hours of care provided. The remaining 40% is now billed at the homemaker rate of $36.20 per hour.

Breaking Down the Math

In 2025, agencies billed 100% of care at HHA rates. In 2026, they are billing 60/40 homemaker to HHA rates. For an agency providing 10 hours of care per week, that is a difference of more than $200. The actual rate reduction is just over 30%.

More Hurdles

In addition to the rate cut and the HHA/Homemaker change, this agency and countless others are struggling to find caregivers for remote areas. Hours of drive time for one visit doesn’t pay enough to entice caregivers.

In most agencies, this one included, drive time and mileage are reimbursed between visits but not for the time to the first visit and after the last visit. This model doesn’t work for rural visits when the drive time is as long or longer than the visit and takes the whole day. Especially with the rate cut forcing lower hourly rates for caregivers, reimbursement for rural visits are necessary.

The Reality of VA in NM

My source described the grim reality over the last six months. What it means for agencies in New Mexico, what it means for caregivers, and especially what it means for veterans is disturbing and infuriating. Agencies in New Mexico, especially those whose client base is primarily veterans have few choices. They can stop serving veterans or they can operate at a loss. This agency knew the catastrophic consequences of no longer serving the veteran population and chose to operate at a loss. They are spending more on caregivers in rural areas than they make. The agency has onboarded more clients, more caregivers, and more staff in the last six months because so many agencies weren’t able to continue providing VA services.

Personal Plea

My source asked me to convey this personal message to agency owners in New Mexico and Texas, and to the industry:

“The Albuquerque VA team is exceptional. They are playing the cards that were dealt to them. These decisions were made above their heads. Support and be kind to your local VA offices. They’re not happy about this; they’re fighting this fight with us.”

When asked what agencies can do to support veterans and agencies, he said:

“The important thing for all of us to remember is what we do is important; we make a difference in the lives of veterans every day. It is important to advocate on behalf of providers and veterans.

Get in front of people who can influence. U.S. Reps, U.S. Senators. If enough people talk, they will have to listen. If they reach a threshold of calls, they have to answer.”

Final Thoughts

The thought of veterans, especially rural veterans, losing their in home care is devastating, as I hope it is for you. For some, this is the only human contact they have. For others, it is the only contact they can have. The consistency and familiarity that comes from having the same caregiver visit at the same time in a familiar setting is vital for veterans with PTSD or dementia. Disturbing that care and then claiming the rate change will not impact veteran care is ignorant and irresponsible. Whether you are operating in Texas and New Mexico or not, please consider writing to Secretary Collins and your local officials to ensure someone with decision-making authority is looking at the reality they have created.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Justice Department’s Next Target

by Kristin Rowan | Jun 19, 2026 | Medicaid, Waste Fraud and Abuse

By Kristin Rowan, Editor

Justice Department's Next Target

New York Sued for Fraud

The past several months, Vice President JD Vance, Dr. Oz, and the anti-fraud task force have investigated home health and hospice agencies suspected of fraud. Much of the focus has been in Minnesota, Georgia, and California. Now, New York joins the list of targeted states, as the Justice Department suis the New York State Department of Health, the state’s Medicaid director, Public Partnerhsips, LLC (PPL), the company operating the $10 billion Consumer Directed Personal Assistance Program (CDPAP) for the state.

CDPAP Management

Prior to the fall of 2024, CDPAP was managed by hundreds of individual agencies. The state opted to consolidate management into one firm and selected PPL. At the time, CDPAP was one of the largest public health benefits programs in the state with more than 250,000 patients.

Justice Department Allegations

Skimming

In the lawsuit, the Justice Department alleges unauthorized profits going to PPL. These profits allegedly come from PPL skimming a percentage of each hour of care billed to Medicaid. The skimmed percentage, according to the suit, amounts to millions of dollars.

Favored Vendor

The Justice Department further alleges PPL was untruthful in its bid regarding its staffing plan, its financial readiness to handle the contract, and the quality of its software, among other aspects of the plan.

The Department of Justice is blaming New York Governor Kathy Hochul and her administration for allowing the fraud. The DOJ alleges PPL was “preselected” as the winner of the contract in a fixed bid process.

Misrepresentation

The lawsuit further alleges that PPL won the contract after a “sham bid” process. The Justice Department claims PPL intended to stray from the representations made in their bid, that the New York Department of Health learned of the deceit, and failed to hold PPL accountable.

JD Vance Speaks

At a recent campaign event, Vice President JD Vance spoke about the lawsuit.

“You do not want your government facilitating fraud; you want your government fighting against fraud. You know what these fraudsters are doing? They’re taking advantage of American generosity to enrich themselves.”

JD Vance

Vice President of the United States

Response

New York State Department of Health spokesperson Cadence Acquaviva called the lawsuit a “baseless complaint” and an attempt by Republicans to “score political points at the expense of vulnerable New Yorkers.” Acquaviva called the lawsuit “inexcusable and completely lacking in merit.”

The Rowan Report reached out to PPL for comment, but did not hear back as of the publication of this article. We will provide updated information as it becomes available.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Solutions Provider Expands Home Health Footprint

by Kristin Rowan | May 29, 2026 | M&A

by Kristin Rowan, Editor

Solutions Provider Expands Home Health Footprint

An Interview with Mike Scarbrough

LivTech may not be a name with which you are familiar. I wasn’t. But, you are likely familiar with the brands this private equity firm has acquired. Worldview reduces document processing time for home health and hospice agencies. Qualis manages DME workflows for hospice agencies. Ally handles invoicing, payments, and record-keeping for 1099 caregivers while keeping registries aligned with regulations. And now, LivTech has acquired Alora, the cloud-based full workflow solution for home health, hospice, and home care.

Why Alora?

CEO Mike Scarbrough, who saw a lot of industry growth when working in the ambulatory space, got excited about the post acute market. LivTech has now been operating in the care at home space for a while with their acquisitions of Worldview and Thornberry. With that foothold, the company looked to have a significant presence in home health, tie all their care at home products together, and provide their customers with a migration path forward, Scarbrough said.

Alora is built for home health, hospice, and home care

“In home health and home care, a lot of our customers are or are contemplating doing both. We hear a lot that choosing different solutions for home health, home care, and hospice is difficult. We have a suite of products that will do all three after the integration, which will take months, not years,” Scarbrough said. “The Alora platform was very purpose-built, has a rich feature set, has consistently high NPS scores, and has very low churn. More importantly, Alora has a great personality and culture fit with LivTech.”

What to Expect

I asked Scarbrough what the future holds for LivTech as the integration finalizes and what LivTech and Alora customers should expect. He explained that LivTech offers solutions, not software. Their software platforms form the foundation, but their customers also get support, road maps, and best practices.

“The people we work with are care oriented, as they should be. We want to take the work they do and make it easier so they can focus on what matters, patient care.”

Mike Scarbrough

CEO, LivTech

The Path

To make the job easier for the caregivers, LivTech takes what they know as technologists and applies that to what they understand about home health. This involves ambient transcription, chart summaries, drift notification, audits and surveys, and information flow. They also use their understanding of home health to know where NOT to insert their technology: between the caregiver and the care. The solutions augment care and make suggestions, but never make decisions about care.

AI and the Future of LivTech

The question asked of every solution provider, technologist, and consultant recently is “What about AI?” Scarbrough noted the dramatic changes in the AI tool chain in the last six months, changing the pace of software development. He said these changes are going to make some things obsolete and push developers to focus less on how the tech works and more on the problem their trying to solve. We will rely more on expert problem solvers than on tech experts. Scarbrough predicts exponential growth in what software can do, real solutions that weren’t possible before.

When I asked how he felt about the future of LivTech after the acquisition of Alora, he said:

“I’m super excited and motivated to grow the business. The people we sell to and the people who work for us continue to amaze with their commitment and passion for the work they do.”

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Fight Loss of Rural Veteran Care: An Interview with Angelo Spinola

by Kristin Rowan | May 29, 2026 | Advocacy, Regulatory

by Kristin Rowan, Editor

Fight Against the Loss of Rural Veteran Care

Deep Cuts Impact All

Last November, the U.S. Department of Veterans Affairs (VA) announced the 2026 VA Fee schedule, which became effective January 1st. There were significant changes to the fee schedule compared with previous years. By far the most concerning, though, was the “rate restructuring” for Home Health Aide and Homemaker codes in Texas and New Mexico.

Rate Restructure

Prior to 2026, Texas VA had a tiered fee structure. The tiered structure applied different rates for geographical areas based on _____. The restructure for 2026 applied a single statewide rate. This gave a slight increase in rate for some urban and suburban areas. However, the change created a drastic drop in rates for rural areas. For most Texas rural areas, it is a 43% reduction for Home Health Aides. The restructing results in a 19% decrease in New Mexico.

Tiered Rates

2025 VAFS rates were as high as $67 per hour in some rural areas. The hourly rate covered the time spent in the home, greatly increased travel time compared to urban visits, and differential incentives to entice caregivers to take these shifts that are often short and spread apart. The new statewide rate is $38 per hour. For the highest paying rural areas, this is a 43% rate cut.

Hours per Veteran

In addition to the rate cut, the number of hours per veteran has also dropped to an average 3.4 hours per shift. Some veterans are seeing their monthly hours cut by more than 30%.

Advocating for Change

State and national associations and advocacy groups reached out to the VA. Six senators and congresspeople reached out Doug Collins, secretary of the VA, to express their concerns. The VA has largely not responded to inquiries about the validity of the rate reduction and has not provided the analysis used to decide the new rate.

Notice and Comment Period

Most rate changes like this require advanced notice for agencies to adjust as well as a comment period when interested and impacted parties can contact lawmakers to provide feedback and ask questions. The announcement about these rate changes came in December and went into effect in January. The VA provided almost no notice and did not entertain comments or questions.

Fight Against VA Rate Cuts Texas New Mexico

Collins Responds

“[The rate reductions] reflect our assessment that prior rates for these areas significantly exceeded prevailing market rates. Aligning these rates with market conditions is not expected to affect veteran care.”

Doug Collins

Secretary, U.S. Department of Veterans Affairs

Defying His Objective

When Collins accepted the role of Secretary of the VA, he thanked President Trump for the assignment and asked him, “What would you like me to do?” The President answered, “Take care of my Veterans.” In a statement to the press, Collins outlined how he would accomplish that mission. Second on his list is to “put Veterans as the center of everything VA does, focusing relentlessly on customer service and convenience.”

Fail

Creating care deserts in rural areas and forcing veterans to travel up to an hour to get care is not convenient. Reducing home care hours and raising the probability of veterans having to move to care facilities is not service. Secretary Collins is failing in his objective and failing his directive from the President. More importantly, he is failing our veterans.

Coalition with Polsinelli

The Rowan Report spoke with Angelo Spinola and Heather Looby of Polsinelli. Polsinelli has been actively working on getting the rate changes reversed. Spinola, an employment litigator with a special interest in home care, explained the situation in more detail. According to Spinola there has been little information from the VA and what communication exists has been inconsistent. Many of the letters sent to the VA get no response at all. Spinola says there are legal remedies available, but they are challenging and expensive. In a letter to the VA, Polsinelli outlined the risks and consequences of these actions and gave the VA 30 days to respond.

Join the Fight

Next week, we will bring you real stories of agencies and veterans impacted by the changes in Texas and New Mexico. Their stories are powerful and moving. Even still, you may think this isn’t your fight because

A small enough percentage of your business is impacted
You have agencies in other states making up the difference
You don’t operate in Texas or New Mexico

Angelo cautions:

If they can do it in TX and NM, they can do it anywhere

“They” might be the VA changing rates that are unsubstantiated and contrary to the Administrative Procedure Act.

“They” might be CMS following suit and arbitrarily changing rates without analysis, notice, or comment.

“[Whether you are currently impacted by these changes or not,] the industry needs to get together to address this and join the fight before it’s too late; before it becomes the norm. “

Angelo Spinola

Home Health, Home Care & Hospice Chair, Polsinelli

How You Can Help

Write to your congressperson and senator and urge them to push Collins and the VA to reverse this change

Write to Collins and the VA directly with impact statements and concerns

Join the coalition with Polsinelli – PolsinelliHomeCare@polsinelli.com

Final Thoughts

We have interviews scheduled with providers and veterans to bring you real stories of how this is impacting our industry. We will also continue our discussions with Polsinelli to get additional information and keep you updated on the progress of the 30-day deadline and additional action the coalition will take.

Honor our Veterans

It was just a few days ago that our nation celebrated Memorial Day in honor of the ultimate sacrifice made by so many. There are too many service men and women who never came home. The ones who did risked everything for you, for me, for this country, and for the ideals that make the United States what it is. They deserve to come home after that service and age with dignity and grace in their homes for as long as they can. We owe them at least that. We all have our own stories and paths that led us to care at home, but at the core of each of those stories is care. Our veterans need that care now. Reach out, write, advocate, join. Whatever you are able to do, now is the time for action.

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicare Moratoria

by Kristin Rowan | May 14, 2026 | Breaking News, Medicare, Regulatory, Waste Fraud and Abuse

by Kristin Rowan, Editor

Medicare Moratoria

CMS Halts All New Home Health & Hospice Agencies

As part of it’s ongoing efforts to curb Medicare waste, fraud, and abuse, the Centers for Medicare and Medicaid Services (CMS) is taking a bold step. On Wednesday, May 13, 2026, CMS announced a 6-month moratoria on home health and hospice agency enrollment. Aimed at protecting Medicare beneficiaries and taxpayer dollars, the moratoria will temporarily stop new enrollment of providers in home health and hospice, which CMS calls “high-risk” categories and key sources of fraudulent activity. CMS states this effort builds on additional fraud prevention initiatives, including enhanced screening, site visits, and expanded oversight activities across the hospice and home health sectors

More Investigations

Together with Vice President JD Vance’s Anti-Fraud Task Force, CMS will increase its targeted investigations of hospice and home health agencies that are suspected of fraud. CMS promises to use advanced data analytics and to accelerate the removal of fraudulent hospice and home health agencies.

Skirting Authority

CMS investigations revealed that some agencies intent on committing fraud are closing their businesses and reopening under different names in different states to perpetrate additional fraud. The moratoria will prevent these agencies from skirting authority in this manner. Additionally, the moratoria applies to some changes in ownership, which is a common technique used to hide these “bad actors.”

What it Means for You

The moratoria do not apply to existing providers with current enrollments. You can continue to deliver services to Medicare beneficiaries as long as your enrollment is current and in good standing.

Statement from CMS

“We’ve seen systemic and deeply troubling fraud in the hospice and home health space, with bad actors exploiting some of our most vulnerable Medicare patients and stealing money from the American taxpayer. Today we’re shutting the door on fraud—preventing new bad actors from entering Medicare while we aggressively identify, investigate, and remove those already exploiting them. This is about protecting patients, restoring integrity, and safeguarding taxpayer dollars.”

Dr. Mehmet Oz

Administrator, Centers for Medicare and Medicaid Services

More Information

The administration’s anti- fraud, waste, and abuse efforts are ongoing.

Read the CMS Press Release

Full text of the Home Health Moratorium

Full text of the Hospice Moratorium

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Medicaid Reform

by Kristin Rowan | Apr 17, 2026 | Home Health, Medicaid, Regulatory, Waste Fraud and Abuse

by Kristin Rowan, Editor

Medicaid Reform

New Efforts to Stop Fraud Before it Happens

As auditors continue to investigate fraudulent activity, new initiatives through Medicare reform aim to stop fraud before it happens. The new initiative, the Combating Deceptive Practices in Assistance Programs Act adds oversight to the Medicaid program.

Preserve Medicaid through Reform

Chairman of the Joint Economic Committee and Chairman of the House Ways and Means Oversight Subcommittee, Rep. David Schweikert, announced the legislation that would tighten eligibility requirements for home health services through Medicaid. The bill requires Medicaid recipients to prove they are unable to perform three or more ADL’s without assistance.

If we seriously want to preserve Medicaid, and provide for the people most in need, we must crack down on fraud. Reaching people that need these services the most should be the top priority of these programs, not growing one of the largest jobs corps in the state. With the U.S. adding almost $87,000 per second to our national debt, making commonsense reforms can save tens of billions of dollars while protecting the truly vulnerable.”

Rep. David Schweikert

Chairman, Joint Economic Committee and House Ways and Means Oversight Subcommittee

Medicaid Waiver Programs

According to the statement from the Joint Economic Committee, the federal waiver programs that allow states to provide at home care for Medicaid beneficiaries are lacking guardrails and oversight. The state policies are “egregious” and lead to waste, fraud, and abuse.

For example, the New York State Medicaid program includes the Consumer Directed Personal Assistance Program (CDPAP) which allows beneficiaries to choose their caregiver. This broad eligibility program allows enrollees to choose friends or family members with no caregiving experience. New York’s Medicaid spending jumped from $2.5 billion in 2019 to more than $9 billion in 2023 with estimates of $12 billion in 2025.

More Information

Read H. R. 7713

Read the accompanying brief from the Joint Economic Committee: From Care to Cash: Correting Misaligned Incentives in Home Health

# # #

Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Idaho Approves $22M Cut

by Kristin Rowan | Apr 17, 2026 | Advocacy, Medicaid, Partner News

by Kristin Rowan, Editor

Idaho Approves $22M Cut

Provider Reimbursement Rates Slashed

Idaho Governor Brad Little approved House Bill 863 in late March after the bill passed the House and Senate. Little directed the state to balance the budget and sent a recommended list of cuts. Among the recommendations was provider reimbursement rates for residential habilitation services, where lawmakers chose to cut nearly $22 million.

Cut Reverses Raises

The State approved pay raises for providers in 2022. This bill reduces those raises for next fiscal year. Combined with previous Medicaid rate cuts, this amounts to a 10% rate reduction for habilitation providers. Lawmakers say this rate is still 33% higher than four years ago.

An Impossible Decision

Lawmakers say balancing the budget required impossible decisions. For Medicaid, the decision was between cutting the Medicaid expansion, and cutting services for people with disabilities. As evidence of the difficulty of the decision, the proposal was delayed twice and was replaced once with a proposal to repeal Medicaid expansion.

Tighten Your Belt

Co-sponsor of the bill, Senator Julie VanOrden, said to follow the money. “The money [goes] from the state to the provider to the caregiver. Somewhere along there, maybe somebody needs to tighten the belt somewhere…. That might mean, as a provider, I don’t take as much money, but I still pay the people that are doing the work the amount that they need.”

HHAeXchange Responds

The Rowan Report reached out to HHAeXchange president Stephen Vaccaro for a comment.

“Idaho’s recent Medicaid disability-services cuts and Colorado’s proposed reductions point to a broader pattern. When states look for Medicaid savings, home and community-based services (HCBS) are often among the first areas affected. But for people who rely on care at home, these supports are essential. They make it possible for individuals to remain safely in the community, rather than shifting into disruptive, higher-acuity settings.

While cutting HCBS may lower spending in one line item, states can end up shifting costs to more intensive settings, like emergency departments and long-term care facilities. To build a more sustainable Medicaid program, states must look beyond immediate savings and consider the longer-term impact of weakening access to services that help prevent more costly outcomes.

States must continue to address fraud, waste, and abuse to protect the long-term health of Medicaid. However, jeopardizing the critical services that people rely on is not the answer. Oversight and accountability should go hand in hand with preserving access to care at home.”

Stephen Vaccaro

President, HHAeXchange

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Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

California Hospice Fraud

by Kristin Rowan | Apr 10, 2026 | CMS, Home Health, Hospice, Waste Fraud and Abuse

by Kristin Rowan, Editor

California Hospice Fraud

Update 04-16-2026

Reports continue of additional arrests and revoked licenses in the California Hospice Fraud investigations. The anti-fraud task force suspensions rose to 447 hospices and 23 home health agencies this week. The total estimated fraud is more than $600 million. A White House official said, “[the task force] is reviewing and pursuing every possible lead. These suspension numbers, and the dollar values saved, are only going to increase.” Dr. Oz has promised to investigate “every single hospice in California.”

Multiple Arrests and Charges

Hospice fraud has been under investigation with much scrutiny by CMS. National efforts against waste, fraud, and abuse have focused on states with high probability of defrauding the Medicare Trust Fund. On April 9, 2026, California Attorney General Rob Bonta announced charges filed against 21 suspects accused of defrauding the government of $267 million. Five people were arrested and two handguns and more than $750,000 in cash were seized.

Intent to Defraud

After a credible report of fraud, an investigation ensued. The investigation uncovered this scheme. Individuals bought personal identifying information (PII) from people not living in California. They bought the PII through the dark web. They then enrolled these “people” in Medi-Cal, the California Medicaid program. Straw owners purchased 14 hospice companies and started billing Medi-Cal for hospice services for the stolen identities without providing those services.

Location Search

As part of a separate hospice fraud investigation, agencies conducted compliance reviews at a single location in Van Nuys. The address is home to more than 125 individual businesses. Of those, only 19 are licensed by the state and eligible to bill Medi-Cal. 60 percent of the remaining 109 businesses applied for hospice licenses and were denied by the state based on the moratorium on new hospices in place in California since 2021.

The 71 Million Dollar Doctor

Dr. Rajiv Bhuva has connections to Medicare claims from 126 different hospices in California, 115 of which are in LA County. The claims are for almost 2,800 patients. The average doctor cares for 140 patients annually. Dr. Oz confirmed that CMS has revoked Dr. Bhuva’s ability to bill Medicare. Dr. Bhuva has not yet been charged with a crime. A similar case in 2024 resulted in the conviction of Dr. Domingo Barrientos on the charge of conspiracy to commit healthcare fraud. Dr. Barrientos is in federal prison.

Task Force Suspends Providers

A federal anti-fraud task force working in California is investigating both hospice and home health providers. The focus is currently on Los Angeles and LA County, where high numbers of new agencies raised suspicion. As efforts have ramped up, the task force reported suspending 70 providers last week and a staggering 221 total providers suspended so far. The task force anticipates dramatically higher numbers before they’re done. The operation has identified multiple defendants and hundreds of millions in fraudulent claims.

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Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com

Accountability and Sustainability in Medicare Advantage

by Kristin Rowan | Apr 10, 2026 | CMS, Medicare Advantage, Regulatory

by Kristin Rowan, Editor

Accountability and Sustainability

CMS Finalizes 2027 Medicare Advantage and Part D Changes

As part of its ongoing efforts to reduce unneccessary payments, CMS issued the 2027 Medicare Advantage (MA) and Part D announcement to “improve payment accuracy” in both programs. The changes aim to make MA sustainable, allow beneficiaries to choose the best health coverage for their needs with maximum value, and make Medicare coverage more affordable.

“CMS’ vision for Medicare Advantage and Part D is clear: a great choice for seniors and a smart deal for taxpayers. The Rate Announcement improves payment accuracy and strengthens competition based on quality—not on coding practices—helping put the program on a more sustainable path for the long term.”

Chris Klomp

Director of Medicare and Chief Counselor, U.S. Department of Health and Human Services

Rate Changes for MA Risk Adjustment Model

The Rate Announcement policy changes address coding differences between MA and traditional Medicare. MA is moving toward a risk adjustment system guided by:

Reducing administrative burdens for plans and providers
Equalizing competition for all MA plans regardless of size or resources
Achieving payments that accurately reflect health risk
Facilitating the efficient use of healthcare resources, enhanced program integrity, and greater accountability

CMS will continue using the 2024 risk adjustment model in pursuit of these changes. However, CMS will exclude diagnosis information from unlinked chart review records from risk score calculation. There is an exception from the exclusion for beneficiaries who switch MA providers. The exclusion does not apply to PACE organizations, which will continue to use a blend of the 2017 and 2024 risk adjustment models. CMS expects this change to lower payments to MA plans by more than $7 billion in 2027.

Part D Risk Adjustment Model

Deductible

Part D beneficiaries cover 100% of the costs of their prescriptions, except insulin and recommended vaccines, until the deductible is met. The 2027 deductible will increase from $615 to $700.

Out-of-pocket maximum

After sunsetting the coverage gap phase in 2025, beneficiaries no long have an initial coverage limit. The initial coverage phase lasts until the annual out-of-pocket (OOP) maximum is reached. CMS is also using the API indexing method to establish the annual OOP threshold. The annual OOP will increase from $2,100 to $2,400 in 2027.

Calculation method

CMS can use one of two methods to update the annual deductible amount. The annual percentage increase (API) measures the average plan expenses per beneficiary. The Consumer Price Index (CPI) measures the annual percentage increase of all items across the U.S.

The 2026 API is 9.37%. The 2026 CPI is 2.31% CMS chose to use the API indexing method to set the 2027 deductible.

Accountability and Sustainability API and CPI 2027 Medicare Advantage Part D

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Kristin Rowan is the owner and Editor-in-chief of The Rowan Report, the industry’s most trusted source for care at home news. She is also a sought-after speaker on Artificial Intelligence, Technology Adoption and Lone Worker Safety. She is available to speak at state and national conferences as well as software user-group meetings.

Kristin also runs Girard Marketing Group, a multi-faceted boutique marketing firm specializing in content creation, social media management, and event marketing. She works with care at home software providers to create dynamic content that increases conversions for direct e-mail, social media, and websites. Connect with Kristin directly at kristin@girardmarketinggroup.com or www.girardmarketinggroup.com

©2026 by The Rowan Report, Peoria, AZ. All rights reserved. This article originally appeared in The Rowan Report. One copy may be printed for personal use: further reproduction by permission only. editor@therowanreport.com