Home Health Agencies’ Transition to Managed Care Plan ‘Lukewarm At Best’

A reaction to managed care from home care agencies and joint home care/hospice agencies can be described as “lukewarm at best,” according to a new report by The National Council on Medicaid Home Care. 

In July and August, National Association for Home Care & Hospice’s affiliate, the National Council on Medicaid Home Care, surveyed its members as to the status of their adoption of Medicaid managed care in home care.

The council conducted two surveys. The first had 45 respondents, and the second, a modified and more detailed version of the first survey, had 67 respondents, for a total of 112 respondents.


Ranking numerous aspects of their transition to managed care on a scale of 1 to 5, with 1 being a very negative experience and 5 being a very positive experience, all  of the responses averaged between a 2 and 3. 

In Ohio, home health workers — and their agencies — have been struggling to adjust to payment processing changes since the state’s new managed care plan for dual eligibles rolled out locally in July.

Out of the total of those surveyed, 53 stated that their state now has managed care in home care, four stated that they have Medicaid managed care through coordination of dual eligibles, and 51 stated that their state has both Medicaid managed care in home care and through coordination of dual eligibles.


Only three of those surveyed stated that their state does not have Medicaid managed care at all.

For home health services, the most common reimbursement methodology for each services in Medicaid managed care was either per visit or per time unit, with 33 and 17 respondents selecting those answers respectively.

However, the majority of the respondents put “I don’t know” for reimbursement methodology for behavioral health services; home delivered meals; hospice; live-in services; mental health services and private duty nursing, both adult and pediatric; and telehealth. 

“While the transition to Medicaid managed care is filled with challenges, stakeholders are not powerless or voiceless in the matter,” says the National Association for Home Care & Hospice. “Agencies and associations alike should take opportunities to learn from previous experience.”

Access the study here.

Written by Cassandra Dowell

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