State-by-State Advocacy Snapshot: Winter 2026

From consumer protection to fiscal sustainability to workforce protections, HCAOA advocates across the country are actively working to secure stronger policies for home care. Here’s a look at the current issues by state reported at a recent Chapter Town Hall meeting.

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Alabama
Providers are contending with workforce instability, reimbursement misalignment, and increased regulatory scrutiny without clear operational guidance. Recruitment and retention of caregivers remain top priorities.
 
Arizona
The state is working through budget pressures in its developmental disability system, including significant supplemental funding requests. A hastily implemented assessment tool was withdrawn after stakeholder pushback, and multiple funding bills related to reimbursement and residential services remain in play.
 
California
The chapter has been building strong relationships with regulators around enforcement, and the state recently secured funding for additional agents to combat unlicensed operators. Advocacy continues on closing referral loopholes and strengthening consumer protections.
 
Connecticut
Connecticut's chapter is engaged on multiple fronts: caregiver training requirements, Medicaid reimbursement advocacy, a proposed caregiver tax credit, and registry implementation and enforcement issues.
 
Florida
Florida is working through proposed changes to its family caregiver program, including limited controlled-substance administration. Budget discussions are ongoing around private duty nursing rates, and the chapter is pursuing rural health transformation funding while pressing for greater transparency in nurse registry models.
 
Georgia
Georgia is navigating complex budget negotiations in an election year. While Medicaid waiver funding remains stable, broader aging services funding faces pressure. The chapter is also engaged on audit reforms, fingerprinting consolidation, and structural Medicaid policy changes.
 
Hawaii
As a newer chapter, Hawaii is focused on education and awareness. Home care has been left out of several recent legislative proposals — including caregiver tax credits, workforce funding, and dementia training — and the chapter is actively advocating for inclusion. A promising initiative targeting seniors who don't qualify for Medicaid but can't afford private pay is gaining traction.
 
Illinois
After successfully addressing hospital referral practices, Illinois is now targeting transparency in assisted living referrals. The chapter also secured inclusion of home care workers in worker protection legislation. Gray market activity remains a persistent concern.
 
Kansas
HCAOA is actively submitting comments on Kansas's proposed revisions to Home Health Agency Regulations, advocating for rules that reflect operational realities, minimize administrative burden, and protect access to care without compromising quality standards.
 
Kentucky
Kentucky providers face significant headwinds: lengthy licensure delays, outdated administrative processes, and low Medicaid reimbursement rates. The chapter is building key legislative relationships and exploring veteran-focused advocacy pathways as a strategic entry point.
 
Maryland
Gov. Wes Moore has issued a directive requiring the Maryland Department of Health to create a statewide registry of home care workers employed by Residential Service Agencies. The registry would publicly list caregiver information and be accessible to employee organizations, which raised serious privacy, operational, and workforce concerns. HCAOA, in coordination with local partners, is advocating to address administrative burden, data protection risks, and broader labor implications.
 
Michigan
Michigan is managing split legislative control and budget uncertainty. Workforce cost pressures tied to minimum wage and earned sick time laws are adding strain, and the chapter is monitoring broader Medicaid budget implications alongside fallout from recent auto no-fault changes.
 
New Jersey
New Jersey's chapter is adjusting to a new gubernatorial administration, with several regulatory proposals — including domestic worker regulations — currently on pause for review. The chapter is advancing audit reform legislation and working to secure exemptions from overlapping regulatory requirements.
 
New York
New York providers face a tough environment: wage compression, heavy regulatory oversight, and growing competition from unlicensed providers. The chapter is calling for shared advocacy playbooks and stronger coordination to address reimbursement pressure and compliance complexity.
 
Ohio
Ohio is pursuing legislation to allow home care caregivers to administer medications, aligning state policy with existing Department of Aging standards. The chapter is also monitoring direct-to-consumer Medicaid proposals and continuing to engage state leadership.
 
Pennsylvania
HCAOA is initiating conversations — in coordination with local partners — around a proposed Medicaid state budget request to increase provider reimbursement rates. Early engagement is underway to build a coalition and shape the conversation.
 
South Carolina
South Carolina is pressing for a Medicaid rate increase for personal care and private duty nursing, supporting the Department of Health and Human Services budget request, and pursuing updates to in-home care licensure regulations. An in-person advocacy day is planned to reinforce these priorities.
 
South Dakota
HCAOA worked closely with stakeholders to strengthen language in the state’s home care licensure legislation, securing clearer definitions and better alignment with provider realities. The bill successfully passed both the House and Senate during the 2026 legislative session and is currently awaiting action by the governor.

Tennessee
Tennessee is focused on ensuring home care is included in Medicaid home- and community-based service expansions and on securing improved rate alignment. Certificate of need and Medicaid sustainability are central issues for providers.
 
Texas
Texas providers are dealing with unlicensed competition, persistently low Medicaid reimbursement, and significant VA rate cuts. The state recently approved substantial funding for dementia research. Regulatory modernization, overtime rule impacts, and ongoing issues with the state's e-licensure system remain priorities.
 
Virginia
Virginia is tracking minimum wage legislation and expanded paid sick leave proposals moving through the General Assembly — both carry real cost implications and administrative requirements for providers.
 
Washington
Washington's chapter won a significant advocacy victory, successfully converting a proposed state-level 80/20-style spending requirement into a reporting model instead. The state faces a major budget deficit after prior surplus spending, and a proposed employer healthcare tax is also under review.
 
West Virginia
West Virginia secured significant Medicaid rate increases over the past 14 months and is now working to codify an annual rate study. The chapter is monitoring managed care proposals, certificate of need changes, and sales tax interpretations affecting personal care services.
 
No matter what state you operate in, we want to hear what issues matter to you. Join HCAOA’s monthly Government Relations Office Hours, held the second Wednesday of each month, to ask the HCAOA Government Relations Team questions or raise an issue we should be watching.

Watch the full Chapter Town Hall meeting recording (run time: 1 hour, 24 minutes)