As we settle into the new year, it’s time to reflect on the trends shaping the home and community-based services (HCBS) industry—and what we expect will gain traction in the months ahead. From the continued push toward improved health outcomes to the integration of AI, 2026 is shaping up to be the year when these shifts start driving real change for providers who act. Whether you plan to implement or explore new technologies, care models, or operational approaches, now is the time to align your priorities with the direction the industry is headed.
As more Medicaid beneficiaries present with multiple chronic conditions, the traditional “one-size-fits-all” reimbursement model is becoming less effective. To address this, in 2026, some states are looking to pilot tiered reimbursement models that account for caregivers with specialized skills and the complexity of care they provide.
Some Medicaid programs already use tiered payments based on care needs. For example, Structured Family Caregiving programs in states like South Dakota pay caregivers at different levels depending on the intensity of care required. Additionally, HCBS waiver programs give states flexibility to set payment levels based on the needs of the individual.
Many providers already recognize that specialized training impacts health outcomes. In fact, HHAeXchange’s 2025 Homecare Insights: Provider Voices Survey found that 69.7% of providers offer specialized training for caregivers, with disease-specific care being the most common.
Together, these developments point to a future where personal care reimbursement in Medicaid rewards skill, specialization, and the ability to meet complex needs—aligning payment more closely with outcomes and quality of care.
As states continue tightening EVV requirements, many providers have turned to mobile apps to improve EVV compliance. But in the year ahead, mobile apps will increasingly be used for more meaningful caregiver engagement. When designed well, mobile platforms are true engagement tools, strengthening communication and recognizing caregivers as vital members of the care team—both of which contribute to improved health outcomes.
We believe agencies will use mobile tools during visits to prompt caregivers to record observations and surface concerns early, giving care teams the opportunity to intervene before issues escalate or result in hospitalization.
Direct, two-way communication features will also play a growing role. Chat functionality that allows caregivers to ask questions and resolve issues in real time will impact how supported caregivers feel in the field. With caregiver turnover hovering around 75% (Activated Insights Benchmarking Report, 2025), features that reduce such friction are incredibly valuable.
Any tool that makes a caregiver’s day easier, whether it’s managing their schedules or communicating with the agency—can have a real impact. Our Caregiver Voices Survey reinforces this shift: caregivers say they value technology most when it helps them manage shifts and communicate with their team.
Personal and clinical care lines are blurring. Historically, many agencies focused on one or the other, but as client needs grow more complex, more providers are adding clinical services, condition-specific support, remote monitoring, and wellness programs alongside traditional personal care. This integrated approach supports more comprehensive care plans, diversifies revenue sources, and helps reduce avoidable hospitalizations by connecting all client needs in one place.
Dementia care is accelerating this shift. Many people receiving personal care today live with Alzheimer’s or other cognitive conditions. As a result, states are increasingly treating dementia care as a core competency rather than a niche offering. For example, Florida now requires dementia-specific caregiver training, and other states are exploring similar expectations to ensure safety, stability, and quality of care.
A concrete example of where integrated care models are headed is CMS’s GUIDE Model. GUIDE (Guiding an Improved Dementia Experience) is designed to transform dementia care by integrating medical, supportive, and care-coordination services into a single, team-based approach. Participating organizations work with interdisciplinary teams to deliver continuous care management, caregiver education, and connections to community resources, with the goal of reducing hospitalizations and supporting people living with dementia. Hundreds of provider organizations have already joined the model, and many report that GUIDE enables care coordination they otherwise couldn’t fund through traditional reimbursement.
As personal care, clinical services, and dementia support continue to converge, agencies will need technology and operations that provide visibility across all aspects of care.
The “food as medicine” concept is moving from policy discussions to operational reality for homecare providers, particularly as more states begin offering medically tailored meals to Medicaid members. New York is an early adopter, expanding nutrition benefits for high-risk individuals who need food that supports chronic disease management, recovery, and overall stability at home. As these programs grow, caregivers will play a central role in ensuring clients receive meals that align with specific health needs.
This shift could introduce new considerations for agencies, including:
Homecare platforms that enable caregivers to record real-time observations about eating habits, preferences, and nutrition-related health improvements can provide states and payers with critical insight into program effectiveness—helping refine meal plans and identify members who may be at risk.
Artificial intelligence has been a buzzword in homecare for the last few years, but its real value is finally coming into focus. HCBS agencies are exploring how it can reduce manual administrative work.
In practice, this will involve applying AI to everyday operations: flagging scheduling conflicts before they happen, enabling faster schedule adjustments when visits change, and reducing the manual corrections that slow down billing and increase the risk of denials. The desired result is cleaner data, fewer exceptions, and less rework for staff.
Most agencies aren’t starting from scratch. Digital systems for EVV, scheduling, and billing are already in place; AI makes those systems even more efficient and less error- prone. Rather than adding complexity, it works in the background to surface issues earlier and automate steps that once required human review.
The trends shaping HCBS in 2026 reflect a natural evolution of the industry. Payment models are becoming more nuanced, care delivery is increasingly integrated, and technology is being applied in more purposeful ways to support caregivers and operations alike.
The agencies that will find the most success will focus on equipping caregivers with better tools to communicate and document care, reducing administrative friction for back-office teams, and gaining clearer visibility across services as care models expand. With the right approach, these shifts create opportunities to strengthen day-to-day operations while keeping caregivers and clients at the center of everything.
HHAeXchange’s agency management platform supports agencies as they make these adjustments—strengthening compliance, empowering caregivers, and simplifying everyday workflows.
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