Preparing for 2027: What Home-Based Care Leaders Should Be Planning Now
by Jamie Daugherty, Executive Director

October has a way of turning next year’s planning into something we will get to after this week’s priorities. In home-based care, that can mean reaching December with a budget nearly finished and important operational decisions still unresolved.

We do not have every answer about 2027 yet. But we have enough information to begin making thoughtful decisions about finances, staffing, compliance, and the services our communities need.

Build flexibility into the budget.

The CY 2027 home health payment rule remains proposed as of this writing. Agencies should identify the assumptions in their budgets and schedule a review when the final rule is released. For hospice, the FY 2027 final rule is already in effect, and CMS published corrections to payment rates and wage index information in September.

Across home health, hospice, and in-home care, planning should account for more than reimbursement. Wages, benefits, mileage, insurance, technology, and the time required to manage authorizations all belong in the discussion. Test what happens if referrals fall short, a key position stays vacant, or collections slow.

Match growth plans to staffing capacity.

A higher census target needs a staffing plan behind it. Before committing to growth, consider which disciplines, shifts, or geographic areas are already difficult to cover.

For rural providers, travel time and backup coverage deserve particular attention. A position may look adequate on paper while leaving little room for leave, orientation, or unexpected absences.

Ask managers where the current model is most vulnerable—and what would help retain the people already doing the work. Sometimes the most useful investment is better onboarding, scheduling support, or supervisor development.

Verify that recent changes are working in practice.

A revised policy or completed training does not tell us whether a new process is being followed consistently.

For example, hospices must now provide the written election statement addendum for each election. CMS has announced limited enforcement discretion through December 31, 2026, while the requirement remains in place. This is a useful window to review actual admission records and correct gaps before January.

Apply that same approach to documentation, quality reporting, complaints, and emergency preparedness: choose a few meaningful checks, assign responsibility, and follow through on the findings.

Check the assumptions behind expansion.

New services or locations require a realistic timeline for staffing, licensing, enrollment, and cash flow. CMS’s nationwide home health and hospice enrollment moratoria are an important consideration for projects requiring new Medicare enrollment. Confirm how the restrictions apply before committing resources.

Oregon hospices should also keep SB 1575 implementation on their planning calendars. OHA’s published rulemaking schedule targets rules being operative by January 1, 2027; final requirements and effective dates should guide implementation.

Bring concrete evidence into advocacy.

As we prepare for Oregon’s 2027 legislative session, members can help by documenting barriers to timely care. Authorization delays, staffing limitations, and referrals that cannot be accepted become more useful advocacy evidence when we can explain their frequency and effect on patients.

Please share those patterns with OAHC without patient-identifying information. Your experience helps us explain what providers and communities need.

At your next leadership meeting, identify three decisions that need to be made before year-end. Give each an owner, a deadline, and a clear next step. That is a manageable place to start—and a practical way to enter 2027 better prepared.