The Data Is Clear - Home Care Demand is Growing Faster Than Capacityby Jamie Daugherty, Executive Director For years, providers across Oregon have been sounding the alarm: demand for care in the home continues to rise, while workforce and provider capacity struggle to keep pace. Now, new national data confirms what many of us experience every day. The recently released 2026 Medicaid Home Care Chartbook, published by the Research Institute for Home Care and the National Alliance for Care at Home, provides the first comprehensive national look at Medicaid-funded home care services and the individuals who rely on them. (Research Institute for Home Care) The findings should capture the attention of policymakers, providers, and communities alike. More People Need Care at Home Than Ever Before According to the Chartbook, approximately 3.3 million individuals received Medicaid-funded home care services in 2023, representing nearly half of all Medicaid HCBS participants nationwide. Personal care services accounted for nearly two-thirds of all home care claims. (Home Care Association of Florida) At the same time, the number of individuals receiving services is growing faster than the number of providers available to serve them. The report found that the ratio of Medicaid home care participants to providers increased from 59-to-1 in 2019 to more than 65-to-1 in 2023, highlighting a widening access gap. (SonderCare) For rural states like Oregon, these trends are especially concerning. Many communities already face workforce shortages, long travel distances, and limited provider availability. As demand continues to increase, maintaining access to services becomes even more challenging. Why This Matters in Oregon Oregon has long been recognized as a national leader in home and community-based services. Our state has invested heavily in helping older adults and individuals with disabilities receive care in their homes rather than institutions. But leadership does not eliminate challenges. Providers throughout Oregon continue to report:
The Chartbook reinforces that these challenges are not isolated to Oregon—they are part of a national trend that requires attention and action. (Research Institute for Home Care) Policy Decisions Matter One of the most valuable aspects of the new Chartbook is its focus on how federal and state policy decisions affect access to care. The report examines Medicaid eligibility, managed care participation, dual-eligible beneficiaries, workforce trends, and the potential impact of recent federal Medicaid policy changes. (Research Institute for Home Care) Data alone does not solve problems, but it does help policymakers understand the consequences of their decisions. When legislators debate Medicaid funding, reimbursement rates, workforce investments, or regulatory requirements, these discussions directly affect whether Oregonians can access care when they need it. Advocacy Starts with Evidence As providers, we often tell stories about patients waiting for services, families struggling to find caregivers, and agencies forced to limit admissions because of workforce shortages. Those stories matter. What makes this new Chartbook particularly powerful is that it pairs those stories with national evidence. The result is a stronger case for investing in the home care workforce, reducing barriers to care, and ensuring that Medicaid home care remains available for the individuals who depend on it. Looking Ahead The Oregon Association for Home Care will continue monitoring federal and state policy developments affecting home and community-based services. We encourage members to review the Medicaid Home Care Chartbook and use its findings in conversations with policymakers, community leaders, and stakeholders. The future of healthcare increasingly depends on care delivered in the home. The question is whether we will make the investments necessary to meet the growing demand. The data suggests we cannot afford to wait. |