The 2026 Medicaid Home Care Chartbook, released by the National Alliance for Care at Home and the Research Institute for Home Care, provides the most comprehensive national analysis to date of Medicaid-funded home care services, offering critical insight into utilization, workforce trends, and the evolving policy landscape.

As the first report of its kind focused specifically on home care within the broader home- and community-based services (HCBS) framework, the Chartbook establishes a data-driven foundation for understanding how Medicaid home care is delivered and where the system is under strain.

For Florida, the findings reinforce what providers already know: demand is rising, workforce capacity is not keeping pace, and policy decisions at the federal and state levels will directly shape access to care.

National Snapshot: A Growing Program Under Pressure

The Chartbook finds that approximately 3.3 million individuals received Medicaid-funded home care services in 2023, representing nearly half of all individuals receiving HCBS.

Key national trends include:

• 45% of home care users are dually eligible for Medicare and Medicaid
• 56% of HCBS participants receive home care services
• Personal care dominates service delivery, accounting for 62.7% of all claims
• 48% of home care users receive services through managed care organizations (MCOs)

The data also underscores the central role of home care in supporting aging and disabled populations, with utilization concentrated among individuals qualifying through aging (10.5%) and disability (12.3%) eligibility pathways.

At the same time, capacity constraints are becoming more pronounced. The ratio of participants per provider increased from 59:1 in 2019 to 65.65:1 in 2023.

Florida Snapshot: Key Data Points

The Chartbook provides several notable findings specific to Florida’s Medicaid home care landscape:

• 27% – Share of state users enrolled in Medicaid in 2023
• 19% – Share of HCBS participants receiving home care services
• 97% – Share of home care users served through managed care
• 87% – Share of HCBS home care users who are dually eligible
• 97% – Share of dual-eligible HCBS home care users enrolled in managed care
• 49% – Share of HCBS home care users enrolled in Special Needs Plans (SNPs), the highest in the nation
• -0.1% – Projected change in Medicaid home care utilization by 2034

These figures reflect Florida’s high reliance on managed care delivery models and integrated Medicare-Medicaid coverage, particularly among dual-eligible populations.

Federal Policy Outlook: Projected Changes to Coverage

The Chartbook also includes an early analysis of federal Medicaid policy changes under H.R.1 (the One Big Beautiful Bill Act).

Nationally, the report projects:

• A 9.4% reduction in home care users by 2034 (approximately 311,879 individuals)  
• More than 75,000 home care recipients subject to new cost-sharing requirements  

Important Data Considerations

The Chartbook notes data quality limitations that are important when interpreting state-level findings. Some states, including Florida, may undercount certain home-based services.

This suggests that actual home care utilization may be higher than reflected in the data, particularly in states with complex delivery systems.