2026 Home Care Compliance Checklist | Home Health Workforce

1. CMS 80-20 Medicaid Rule

Calculate current compensation percentage Determine what % of Medicaid payments go to direct care worker wages, benefits, and payroll taxes
Identify affected services Homemaker, home health aide, and personal care services under HCBS
Exclude non-qualifying costs Training, travel, and PPE costs are excluded from the 80% calculation
Assess gap to 80% threshold If below 80%, plan to increase caregiver pay or reduce admin overhead
Check for hardship/small provider exemptions Contact your state Medicaid agency about available exemptions
Prepare for state reporting requirements Year 3-4 States must begin collecting and reporting compensation data
Achieve full compliance 2030 80% minimum threshold takes full effect in Year 6

Verify EVV captures all 6 required data points Service type, individual receiving service, date, start/end time, location, provider identity
Meet tightened data validation timelines Many states now require EVV data verification within 24 hours (down from 72)
Check location accuracy tolerances Geographic verification reduced to 500 feet in most states
Conduct weekly EVV log audits Review for errors, missing data, or patterns indicating systemic issues
Include EVV in caregiver orientation Hands-on training exercises for all new hires
Integrate EVV with billing systems Ensure data flows correctly to prevent claim denials
Monitor state-specific EVV requirements Watch for vendor transitions, service expansions, updated rules

Review state minimum wage and overtime laws State laws may exceed federal requirements regardless of federal changes
Assess current overtime scheduling practices Identify caregivers regularly scheduled for 40+ hours/week
Monitor the DOL proposed rule status Companionship/live-in exemption rule may restore agency exemptions
Consult employment counsel Get state-specific guidance before making policy changes
Do NOT change policies until rule is finalized The proposed rule is not yet final; enforcement guidance may change

Designate compliance ownership Assign a compliance officer or shared responsibility team
Set up automated credential tracking 60/30/7-day reminders before license and certification expirations
Schedule monthly compliance audits Review upcoming expirations, training requirements, documentation gaps
Document all training and policy decisions Maintain clear records for audit defense
Join industry associations for regulatory updates HCAOA, PHI, state HHA associations