WASHINGTON, D.C. – Reductions in federal Medicaid funding stemming from the One Big Beautiful Bill Act (OB3) are working their way into state budgets. Provider reimbursement must be protected to ensure the benefit remains available, continuing to save taxpayer dollars overall while allowing people to recover in the home, where they want to be.
AAHomecare’s payer relations and state government relations work is built to address that pressure on four fronts: defending Medicaid rates state by state, protecting the DME benefit itself, educating payers on what HME delivers, and giving members better data to negotiate rates with Medicaid managed care plans.
Rate stability: 36 states and a Coordinated Strategy
Rate stability efforts are active in 36 states, carried out by AAHomecare often in coordination with state and regional association partners and industry stakeholders. Rate floors, MCO oversight, and budget-bill amendments remain the most effective tools. North Carolina’s Medicaid DME rate floor, now extended through June 30, 2029, shows what sustained multi-year engagement can produce.
To keep that work aligned, AAHomecare leads monthly OB3 meetings bringing together state and regional association executive directors, VGM, NCART, and other industry stakeholders. The meetings:
- Track what is happening across the country because of OB3,
- Collaborate on resources showing the value of protecting the DME benefit for Medicaid beneficiaries as a cost-savings measure,
- Highlight strategies working in one state that could benefit patients and providers in another, and
- Maintain a consistent strategy, effort, and set of advocacy talking points in advocacy.
Supporting resources are posted on AAHomecare’s State Medicaid and Medicaid Managed Care page, including a state environmental scan estimating the impact of federal funding cuts and potential changes in the uninsured population, an advocacy white paper, and an OB3 education PowerPoint members can adapt for their own state conversations.
Medicaid Program Integrity
Rate advocacy is harder in states where fraud, waste, and abuse concerns dominate the conversation — so AAHomecare is responding to that issue directly. The Association’s Medicaid Program Integrity page gathers what providers and state associations need to engage constructively:
- Information on federal action affecting Medicaid programs
- Tracking of statewide DMEPOS moratoriums
- AAHomecare’s anti-fraud statement
- Sample letters to Medicaid directors on how the industry can partner to combat fraud, waste, and abuse
The message to state officials is consistent: legitimate providers are allies in program integrity, and blunt instruments like broad moratoriums restrict beneficiary access without addressing bad actors.
Payer Education
AAHomecare’s Payer Relations Council is developing the next generation of payer-facing education, including an updated Medtrade education series focused on working with payers, sharper talking points, resources on how DME providers can be effective partners to payers with improved patient outcomes, and materials written for payers to understand how the industry operates. The bottom line is total cost of care: DMEPOS keeps patients in the home and out of higher-cost settings, and payers make better coverage decisions when they understand that math.
At the Table with National Payers
Payer relations staff continue direct engagement with major national and regional plans, positioning AAHomecare as a trusted resource payers can turn to on industry questions and priorities. These conversations include coverage policy, contracting practices, and operational friction — and serve as an avenue for member-reported issues to become agenda items.
Payer Transparency Portal: third refresh unlocks trend analysis
The AAHomecare Payer Transparency Portal, built in partnership with Medlyze, has completed its third data refresh. The current version covers:
- Approximately 200 payers (more than double the last refresh)
- Approximately 1,500 billing codes (nearly 500 more than the last refresh)
- Medicaid rates in a dedicated tab, in addition to the Medicaid rate displayed by HCPCS code in the State and Payer tab
With three refreshes now in hand (2024, 2025, 2026), the portal supports AAHomecare’s ability to analyze trends for advocacy and allows members to see how a payer’s rate for a given code has moved across three years, benchmark against national, regional, bid-region, state views, and bring documented rate history into a contract negotiation.
A contracting module is coming soon, with added benefits for AAHomecare members. The Payer Relations Council is reviewing the currently available product and providing feedback. AAHomecare’s Payer Transparency Portal is a free provider member benefit — 299 member companies are using it to date.
What members Can Do
Review and compare your top codes in the Payer Transparency Portal to benchmark data before your next contract renewal. Use the OB3 education deck and environmental scan in conversations with your state Medicaid agency and legislators. Tell us what you are seeing on rates, MCO behavior, or program integrity actions in your state — state-level intelligence is what drives the monthly meetings and shapes where the Association engages next.
Listen to fellow members discuss how payer tools have helped their payer negotiations:
For more information on payer relations and state government relations activities, contact Laura Williard, senior vice president of Payer Relations, David Chandler, vice president of payer relations, or Cadie McGonagill, senior director of Payer Relations.