BREAKING NEWS: Health (2)

Readers Balk at ‘Gold Standard’ of Autism Treatment

Tue, 20 Jan 2026 10:00:00 +0000

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

KFF Health News received dozens of letters in response to an article last month describing how state budget shortfalls have led to cuts targeting therapies that many families of autistic people call essential. Here is a sampling:

Autism Care: Pros and Cons

I am writing to provide additional context and research for your article on state cuts to the autism therapy known as applied behavior analysis, or ABA (“It’s the ‘Gold Standard’ in Autism Care. Why Are States Reining It In?” Dec. 23).

While the piece focused on caps or cuts in service hours being a harmful thing, there have been recent studies showing that increased hours of therapy do not lead to better outcomes for autistic children. While different families certainly have different needs that should be addressed individually with clinicians, and while some children may struggle with reduced intervention hours, it’s important to note that dire predictions about families losing hours of services are not borne out by research.

Another important piece of context missing from this article is that ABA is considered a controversial intervention among many in the autism community. While many families have positive experiences, many other families and autistic adults strongly criticize ABA and have described widespread abuse and trauma from it. Newer research is beginning to provide empirical confirmation for these reports of trauma from ABA.

An article about ABA that leaves out this controversy is not a complete picture. At a time when autism is on the national stage and autistic people are routinely dehumanized by our leaders in government, it is critical to think about how coverage about autism is framed and whose voices are centered and included.

In stories about ABA, I believe it is crucial to include autistic voices (such as people who identify as ABA survivors, and autistic parents of autistic children, who are more likely to avoid, quit, or criticize ABA). It is responsible reporting to ask why ABA is widely criticized by so many who have experienced the intervention, and why this criticism is unique to ABA and not seen with other autism interventions, such as speech therapy and occupational therapy. Additionally, it’s essential to investigate the ABA industry’s response to these critiques. (Has the industry collected data or conducted research on what aspects of its past or current interventions have caused harm? Has it changed training or certification requirements for interventionists to address any “bad apples” among therapists? Has the industry engaged with abuse survivors or autistic-led organizations in making changes to practices and policies? Have safeguards been created and required in behavior plans? Have policies and ethical guidelines been updated to address critiques from autistic adults?)

Ethics and safeguards, as well as current research, surrounding an intervention for vulnerable children are a critical part of any article about whether taxpayer money is being used responsibly for a controversial autism intervention.

— Kim-Loi Mergenthaler, Burlington, Vermont

I work with Behaven Kids, a locally owned ABA therapy provider serving families in Omaha, Nebraska. Thank you for your recent article highlighting the impact of Medicaid ABA rate cuts on Nebraska families and providers.

As a local provider, we wanted to offer additional context. Overutilization was cited in the article as a primary driver of rate reductions; much of that overuse in Nebraska was associated with large, out-of-state companies operating with limited long-term investment in the local workforce. Many of these organizations had access to external funding or staffing pipelines, allowing them to absorb the cuts or exit the state altogether.

In contrast, Nebraska-based providers rely almost entirely on local clinicians and local funding streams. The rapid implementation of the rate cuts, with only weeks for providers to adjust, has placed a disproportionate strain on organizations rooted in Nebraska that are committed to long-term care for families here. In some cases, families experienced service disruptions or lost continuity of care as larger providers scaled back or withdrew.

We believe there is an important distinction to be explored between ethical, needs-based service delivery and the practices that contributed to overutilization concerns. A more targeted policy approach, such as improved provider vetting or more rigorous authorization standards, could better protect families while preserving access to high-quality local care.

If not policymakers, then better to inform families and pediatricians. Many people continue to work with out-of-state providers without understanding the ethical use issues or that their services could be at risk due to the ever-changing market and noncommittal companies.

— Whitney Reinmiller, Omaha, Nebraska

Why are states reining in the “gold standard” in autism care? Well, frankly, it’s not the gold standard.

As I wrote in one of my online publications, nations are spending billions on developmental disability interventions that too often lack fidelity, effectiveness, or accessibility. Meanwhile, hundreds of children and youth remain on long waitlists, many in rural areas receive no services, and families with the highest-needs children often go without support.

Decades of research shows that the most effective and cost-efficient interventions occur when care is:

Delivered in natural environments and daily routines.
Inclusive of parents and natural caregivers.
Provided with fidelity to evidence-based practices.

We must restructure the system to financially incentivize contextualized, parent-coached interventions and expand telehealth options. Doing so will increase capacity, improve outcomes, and reduce long-term costs to Medicaid, schools, and corrections.

— CR “Pete” Petersen, Hagerman, Idaho

I serve as the chief clinical officer for one of the largest providers of ABA therapy in the country. In that role, I regularly engage with state Medicaid agencies and managed-care organizations across several states on issues related to access, quality, and cost of autism services.

What I am increasingly seeing is states relying on blunt instruments to control spending, primarily rate reductions and increasingly restrictive utilization management. While these approaches may generate short-term savings on paper, they often create unintended and counterproductive consequences. They do not differentiate between clinical complexity, risk, or progress, and they disproportionately impact providers serving higher-need populations.

In practice, this leads to workforce instability, reduced access to care, longer waitlists, and greater reliance on crisis services and emergency systems. Families experience disruption and uncertainty, and states ultimately absorb higher downstream costs when care becomes less effective or less available.

There is a more sustainable path forward. Instead of focusing narrowly on rate cuts or hour reductions, states can move toward models that incentivize outcomes and appropriate reductions in intensity and length of care over time. This requires standardized, risk-adjusted measures of progress, clear and defensible discharge criteria tied to functional outcomes, and payment structures that reward timely, durable improvement rather than volume alone.

Outcome-aligned approaches create better incentives for providers, greater transparency for families, and more predictable, responsible spending for states. The goal should not be simply to reduce utilization, but to reduce dependency through effective care.

— Timothy Yeager, Fresno, California

The Broader Risks of Body Sculpting

Kudos on an excellent, very important article (“The Body Shops: After Outpatient Cosmetic Surgery, They Wound Up in the Hospital or Alone at a Recovery House,” Dec. 23).

In addition to infections/sepsis and medication overdose, a person may die from fat embolus, in which a piece of fat tissue gains access to a blood vessel and is carried to the heart and lungs. As a pathologist, I’ve seen it (a young woman in her 20s).

People considering body sculpting should also be aware that fat tissue is less well-vascularized than, say, skin or muscle, and therefore is more susceptible to necrosis or infection.

— Gloria Kohut, Grand Rapids, Michigan

ACA Consumers Feel the Pain

The Government Accountability Office’s recent report on fraud in the ACA marketplace should be a wake-up call (“Plan-Switching, Sign-Up Impersonations: Obamacare Enrollment Fraud Persists,” Dec. 10). For those of us working directly with consumers, it merely confirms what we have been reporting to the Centers for Medicare & Medicaid Services for years — with little response.

It must also be acknowledged that Obamacare is broken. Premiums have risen sharply, plan options have narrowed, and affordability remains fragile for millions. Reform is clearly necessary, and reasonable people can debate how best to fix the system.

But consumers should not be punished for these failures — nor forced to absorb higher costs driven in part by CMS’ failure to enforce its own rules. Left unchecked, fraud distorts legitimate enrollment figures, inflates associated program costs, and obscures the true financial performance of the marketplace. The cost of that deception is not borne by fraudsters but ultimately paid by everyday Americans just trying to keep coverage.

We have submitted extensive, evidence-backed complaints on behalf of affected consumers documenting broker-driven fraud across the ACA marketplace. These reports include call recordings, enrollment data, agent National Producer Numbers, timelines, and consumer statements. They identify specific brokers, agencies, dates, and methods of abuse. Yet to our knowledge, CMS has not taken decisive enforcement action against even the most egregious offenders across multiple enrollment cycles. In most cases, CMS has not requested additional documentation at all.

The misconduct is neither isolated nor subtle. We have documented unauthorized agent-of-record changes, fabricated special enrollment periods, and impersonation — brokers posing as consumers to override existing coverage. Often fraudsters abuse the Enhanced Direct Enrollment links, including those powered by platforms such as HealthSherpa, where enrollment pathways are misused to obscure consumer intent, override trusted agents, or facilitate unauthorized enrollments. In some cases, recordings capture consumers explicitly stating they do not want to change plans, only to be enrolled anyway.

Consumers pay the price. Many discover that their coverage has been altered without consent, that their doctors are suddenly out-of-network, or that their premiums have increased. Others lose coverage altogether when fraudulent enrollments collapse under verification reviews. Meanwhile, the brokers responsible often continue operating under new agency names, repeating the same tactics.

The GAO report confirms that ACA broker fraud is systemic. Systems fail when oversight is weak and enforcement is optional. CMS’ inaction has sent a clear message: Documented fraud carries little risk with significant financial gain. Predictably, abuse has expanded.

We can debate.

— Jason Fine, Fort Lauderdale, Florida

A Different Kind of Nursing Home Nightmare

Unfortunately, we learned the hard way that long-term care facilities (nursing homes) saw an opportunity pre-covid to hire a couple of physical therapists and transition a room into a “rehabilitation center” and suddenly become certified LTC/rehab centers (“Broken Rehab: They Need a Ventilator To Stay Alive. Getting One Can Be a Nightmare,” Dec. 2). They could advertise as such to doctors and area hospitals, and they took in a new population of patients. Upon discharge from a hospital, many patients benefit from going to an inpatient rehab facility for a couple of weeks to perhaps a month. Insurance companies decide how long they will pay.

Before the covid pandemic, the LTC facilities had separate wings and rooms just for rehabilitation patients, and they were worked with every day, except weekends, by physical therapists. But then came covid, and the overall attendance of rehab patients went down, so many nursing homes had to close the rehab wings.

But the LTCs still needed the extra revenue, so they just put the rehab patients in with the regular nursing home patients. You can imagine where that went, for not only the patients but the staff. Everyone was a “nursing home patient,” and they were treated as such, especially by the staff.

If you’re a nurse who is used to caring for LTC patients, there’s nothing that is ever “in a hurry.” You schedule activities in with the other time or two you see each LTC patient. Oftentimes, rehab patients are a whole different patient with different, more frequent needs and more frequent medications.

You see the case managers that most hospitals employ to keep the assembly line moving, getting patients in one door and then out the exit door as fast as possible. You have to remember, insurance companies are only going to pay for that hospital patient to be cared for in the hospital for so long. Then the case managers swoop in, have a talk with the attending doctor and everyone (except the patient and family), and agree on a discharge date.

Now comes the list. This is a list that the hospital and the LTC/rehab centers agree on. The family and patient are told nothing about one facility over another. You just better have a facility picked out by the discharge date, or the case managers will do it for you.

So your loved one who needs only physical therapy is off to be most likely mixed in with the regular long-term care patients. And you had better be there every day to watch for your loved one. Twice out of three LTC/rehab visits my wife had, I stepped in and fought with the head of the facility to call the ambulance, because my wife was going downhill, medically, and they didn’t notice it because they weren’t used to noticing when non-LTC patients develop other medical problems, because often the case managers insist on discharging a rehab patient too soon, before they are stable. You need to find a facility that takes care of only rehabilitation patients and is licensed as such.

— Stephen Cripe, Monticello, Indiana

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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Shingles vaccination may slow biological aging in older adults

Tue, 20 Jan 2026 05:45:35 +0000

Shingles vaccination not only protects against the disease but may also contribute to slower biological aging in older adults, according to a new USC Leonard Davis School of Gerontology study.

Irritable Bowel Syndrome (IBS): Common Triggers, Symptom Patterns, and Relief Strategies

Tue, 20 Jan 2026 05:40:59 +0000

IBS symptoms vary by trigger and subtype, affecting digestion, comfort, and daily routines through gut-brain interactions and individualized flare patterns.

Baby Not Gaining Weight: Medical Causes Parents Should Know That Affect Infant Growth

Tue, 20 Jan 2026 05:35:31 +0000

Why a baby not gaining weight may signal underlying health concerns, from feeding issues to congenital conditions, and how early recognition and care can support healthy growth.

A Fresh Start at Home: How Bruusta Is Changing the Way People Brew Kombucha

Tue, 20 Jan 2026 05:25:44 +0000

As January brings renewed focus on healthier routines, Bruusta is gaining attention for its at-home kombucha brewing system, offering a simpler, more sustainable way to enjoy fresh kombucha as part of a daily ritual.

Dr Adam Davenport appointed as CSO to strengthen leadership in integrated drug discovery

Tue, 20 Jan 2026 04:54:00 +0000

We are pleased to announce the appointment of Dr Adam Davenport as Chief Scientific Officer to spearhead our integrated drug discovery offering for biotech and pharmaceutical partners.

Genomic screening uncovers hidden cancer and heart disease risk in young adults

Tue, 20 Jan 2026 01:52:00 +0000

A nationwide Australian pilot screened more than 10,000 adults aged 18–40 years for high-risk genetic variants linked to hereditary cancer and familial hypercholesterolaemia, identifying clinically actionable findings in about 2% of participants.

Adding lean pork to a plant-forward diet supports healthy aging biomarkers

Tue, 20 Jan 2026 01:21:00 +0000

A randomized crossover feeding trial in adults aged 65 years or older found that plant-forward diets incorporating either minimally processed lean pork or lentils produced similar short-term improvements in cardiometabolic and neuroactive biomarkers. Both diets supported metabolic health and functional stability, with no overall adverse biomarker effects attributable to including minimally processed red meat within a Dietary Guidelines–aligned pattern.

Can dietary supplements support nutrition security as climate change disrupts food systems?

Tue, 20 Jan 2026 00:31:00 +0000

Environmental change is reshaping food availability, nutrient quality, and health risks, exposing major gaps in how nutrition science addresses climate-related stressors. This perspective argues that dietary supplements may have a context-dependent role but require rigorous, interdisciplinary research before informing public health action.

Teen girls who play organized sports show lower breast cancer risk biomarkers

Tue, 20 Jan 2026 00:10:00 +0000

This cross-sectional study of 191 adolescent girls found that ≥2 hours of organized recreational physical activity in the past week was associated with lower breast percent water content and reduced oxidative stress. These biomarkers are linked to breast cancer risk, although causality and long-term outcomes cannot be inferred.

National poll: Parents less concerned about children's use of curse words

Mon, 19 Jan 2026 19:57:33 +0000

Today's parents may be growing more relaxed about their children using curse words, according to a national poll.

Plasma protein profiling can help detect cancer in patients with non-specific symptoms

Mon, 19 Jan 2026 19:52:35 +0000

A simple blood test can help detect cancer in patients with non-specific symptoms such as fatigue, pain or weight loss. This is according to a Swedish study from Karolinska Institutet, Danderyd Hospital and others, published in Nature Communications.

Brain structure changes linked to adaptability decline in aging adults

Mon, 19 Jan 2026 18:25:00 +0000

As people age, structural brain changes influence their ability to adapt to the environment. New from eNeuro, Tatiana Wolfe and colleagues at the University of Arkansas characterized changes in the brain across two periods of adulthood that may correspond to changes in adaptive behavior.

Interferon response key to fighting rhinovirus infections in nasal passages

Mon, 19 Jan 2026 16:46:21 +0000

When a rhinovirus, the most frequent cause of the common cold, infects the lining of our nasal passages, our cells work together to fight the virus by triggering an arsenal of antiviral defenses.

Major review finds no autism or ADHD risk from pregnancy Tylenol

Mon, 19 Jan 2026 14:48:41 +0000

A major new scientific review brings reassuring news for expectant parents: using acetaminophen, commonly known as Tylenol, during pregnancy does not increase a child’s risk of autism, ADHD, or intellectual disability. Researchers analyzed 43 high-quality studies, including powerful sibling comparisons that help separate medication effects from genetics and family environment. Earlier warnings appear to have been driven by underlying maternal health factors such as fever or pain rather than the medication itself.

A “dormant” brain protein turns out to be a powerful switch

Mon, 19 Jan 2026 13:53:44 +0000

Scientists at Johns Hopkins have uncovered a surprising new way to influence brain activity by targeting a long-mysterious class of proteins linked to anxiety, schizophrenia, and movement disorders. Once thought to be mostly inactive, these proteins—called GluDs—turn out to play an active role in how brain cells communicate and form connections.

Machine learning can predict patients' responses to antidepressants—while disentangling drug and placebo effects

Mon, 19 Jan 2026 12:30:01 +0000

Depression is one of the most widespread mental health disorders worldwide, affecting approximately 4% of the global population. It is characterized by a persistent low mood, disruptions in typical sleeping and/or eating habits, a lack of motivation, a loss of interest in daily activities and unhelpful thought patterns.

New research shows emotional expressions work differently in autism

Mon, 19 Jan 2026 10:31:17 +0000

Researchers found that autistic and non-autistic people move their faces differently when expressing emotions like anger, happiness, and sadness. Autistic participants tended to rely on different facial features and produced more varied expressions, which can look unfamiliar to non-autistic observers. The study suggests emotional misunderstandings are a two-way street, not a one-sided deficit.

Dehydration in Elderly: 7 Subtle Signs Caregivers Miss (And How to Prevent Them)

Mon, 19 Jan 2026 08:11:58 +0000

Learn the subtle signs of dehydration in elderly adults that caregivers miss. Discover why low fluid intake in seniors poses serious health risks and prevention strategies.

What Causes Falls in Elderly? Medical Conditions & Balance Problems Seniors Must Know

Mon, 19 Jan 2026 08:06:52 +0000

Discover medical conditions causing falls in elderly and balance problems seniors face. Learn risk factors, prevention strategies, and how to maintain independence safely.

Pregnancy Swelling vs Preeclampsia: When Edema Pregnancy Becomes Dangerous

Mon, 19 Jan 2026 08:03:52 +0000

Learn when pregnancy swelling is normal edema vs. concerning signs of preeclampsia. Discover causes, management tips, and warning signs to protect your health.

Epilepsy Explained: Causes, Seizure Types, and Treatment Options for Better Control

Mon, 19 Jan 2026 08:02:12 +0000

Epilepsy explained with causes, seizure types, and treatment strategies to help recognize symptoms and support effective seizure disorder management.

Sudden Appetite Loss Explained: When It Signals More Than Stress or Fatigue

Mon, 19 Jan 2026 08:00:51 +0000

Sudden appetite loss can signal infections, chronic illness, medication effects, or serious disease; learn causes, symptoms, and when to seek medical care.

Cannabis was touted for nerve pain. The evidence falls short

Mon, 19 Jan 2026 05:11:47 +0000

Cannabis-based medicines have been widely promoted as a potential answer for people living with chronic nerve pain—but a major new review finds the evidence just isn’t there yet. After analyzing more than 20 clinical trials involving over 2,100 adults, researchers found no strong proof that cannabis products outperform placebos in relieving neuropathic pain. Even when small improvements were reported, especially with THC-CBD combinations, they weren’t large enough to make a real difference in daily life.

How cancer disrupts the brain and triggers anxiety and insomnia

Mon, 19 Jan 2026 04:35:08 +0000

Scientists have discovered that breast cancer can quietly throw the brain’s internal clock off balance—almost immediately after cancer begins. In mice, tumors flattened the natural daily rhythm of stress hormones, disrupting the brain-body feedback loop that regulates stress, sleep, and immunity. Remarkably, when researchers restored the correct day-night rhythm in specific brain neurons, stress hormone cycles snapped back into place, immune cells flooded the tumors, and the cancers shrank—without using any anti-cancer drugs.

The real danger of Tylenol has nothing to do with autism

Sun, 18 Jan 2026 17:03:01 +0000

While social media continues to circulate claims linking acetaminophen to autism in children, medical experts say those fears distract from a far more serious and proven danger: overdose. Acetaminophen, found in Tylenol and many cold and flu remedies, is one of the leading causes of emergency room visits, hospitalizations, and acute liver failure in the United States.

A new robotic system could perform delicate eye surgery

Sun, 18 Jan 2026 16:30:02 +0000

Retinal vein occlusion (RVO) is a severe disease that occurs when a vein in the light-sensitive layer at the back of the eye (i.e., the retina) becomes blocked, which results in a loss of vision. There are currently a few medical interventions that address RVO, including the periodic injection of medications that block the abnormal growth of blood vessels or of steroids, which reduce swelling and inflammation.

Scientists sent viruses to space and they evolved in surprising ways

Sun, 18 Jan 2026 14:54:24 +0000

When scientists sent bacteria-infecting viruses to the International Space Station, the microbes did not behave the same way they do on Earth. In microgravity, infections still occurred, but both viruses and bacteria evolved differently over time. Genetic changes emerged that altered how viruses attach to bacteria and how bacteria defend themselves. The findings could help improve phage therapies against drug-resistant infections.

A 47-year study reveals when fitness and strength start to fade

Sun, 18 Jan 2026 08:01:41 +0000

A long-running Swedish study has followed adults for nearly five decades, uncovering when physical decline truly begins. Fitness and strength start slipping around age 35, then worsen gradually with age. The encouraging twist: adults who began exercising later still improved their physical capacity by up to 10 percent. It’s a powerful reminder that staying active matters, even if you start late.

How scientists are turning thyme into precision medicine

Sat, 17 Jan 2026 14:48:30 +0000

Thyme extract is packed with health-promoting compounds, but it is difficult to control and easy to waste. Researchers created a new technique that traps tiny amounts of the extract inside microscopic capsules, preventing evaporation and irritation. The method delivers consistent nanodoses and could eventually be used in medicines or food products. It may also work for many other natural extracts.

AI maps the hidden forces shaping cancer survival worldwide

Sat, 17 Jan 2026 14:26:53 +0000

Researchers have turned artificial intelligence into a powerful new lens for understanding why cancer survival rates differ so dramatically around the world. By analyzing cancer data and health system information from 185 countries, the AI model highlights which factors, such as access to radiotherapy, universal health coverage, and economic strength, are most closely linked to better survival in each nation.

Tiny earthquakes are revealing a dangerous secret beneath California

Sat, 17 Jan 2026 10:35:29 +0000

Scientists are uncovering a hidden and surprisingly complex earthquake zone beneath Northern California by tracking swarms of tiny earthquakes that are far too weak to feel. These faint tremors are revealing what lies beneath the surface where the San Andreas fault meets the Cascadia subduction zone, one of the most dangerous seismic regions in North America.

An endocrinologist tried a new weight loss approach and it worked

Sat, 17 Jan 2026 09:25:08 +0000

A simple change in how primary care clinics approach weight management is delivering big public health wins. PATHWEIGH lets patients openly request help and gives doctors the tools to focus entire visits on weight care. In a massive real-world trial, the program halted population weight gain and increased access to obesity treatment. Now, health systems across the U.S. are lining up to adopt it.

Service Robots Revolutionize Healthcare, Retail, and Hospitality With Smart Automation

Sat, 17 Jan 2026 06:41:09 +0000

Service robots are reshaping healthcare, retail, and hospitality by improving efficiency, safety, and daily operations through smart automation.

Early Signs of Parkinson's Disease: Motor and Non-Motor Symptoms You Should Know

Sat, 17 Jan 2026 06:05:20 +0000

Early Parkinson's disease signs include motor and non-motor symptoms. Learn how early recognition supports timely diagnosis and better long-term care.

Gentle Fixes for Baby Constipation: Safe, Proven Relief for Infant Bowel Problems

Sat, 17 Jan 2026 05:59:59 +0000

Discover gentle, research-backed ways to ease baby constipation and infant bowel problems, including safe home remedies, diet tips, and warning signs that need a pediatric visit.

Scientists are rethinking bamboo as a powerful new superfood

Sat, 17 Jan 2026 04:01:50 +0000

Bamboo shoots may be far more than a crunchy side dish. A comprehensive review found they can help control blood sugar, support heart and gut health, and reduce inflammation and oxidative stress. Laboratory and human studies also suggest bamboo may promote beneficial gut bacteria and reduce toxic compounds in cooked foods. However, bamboo must be pre-boiled to avoid natural toxins.

Researchers found a tipping point for video gaming and health

Sat, 17 Jan 2026 03:31:11 +0000

Moderate video gaming appears harmless, but heavy gaming may take a toll on young people’s health. Researchers found that students gaming more than 10 hours a week had worse diets, higher body weight, and poorer sleep than lighter gamers. Below that level, health outcomes were largely similar. The findings suggest balance, not abstinence, is key.

Early Pregnancy Signs: Subtle Pregnancy Symptoms Week 1 That Show Up Before a Missed Period

Sat, 17 Jan 2026 01:49:36 +0000

Discover early pregnancy signs and pregnancy symptoms week 1 that may appear before a missed period, plus when to test and when to talk to a healthcare provider.

Sudden Confusion in Elderly: Key Delirium Symptoms and Warning Signs of an Emergency

Sat, 17 Jan 2026 01:36:59 +0000

Learn what sudden confusion in elderly adults means, key delirium symptoms to watch for, and when urgent medical care is critical to protect brain health.

Baby Rash Causes: How to Spot Diaper Rash vs Allergic Reaction and Choose the Right Diaper Rash Treatment

Sat, 17 Jan 2026 01:12:32 +0000

Learn baby rash causes and how to tell diaper rash from an allergic reaction, plus gentle, effective diaper rash treatment tips to keep your baby's skin comfortable.

Dr. Oz, CMS Leaders Visit Home Health Fraud Hot Spots

Fri, 16 Jan 2026 23:30:55 +0000

The administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, and other CMS officials narrowed in on home health and hospice fraud during recent meetings in Nevada and California.

Oz, CMS Chief Operating Officer Kimberly Brant and Director for Medicare Chris Klomp paid a visit to Nathan Adelson Hospice in Nevada and subsequently held a roundtable listening session with LeadingAge, the National Alliance for Care at Home, the National Partnership for Healthcare & Hospice Innovation (NPHI), the California Hospice & Palliative Care Association and about 15 hospice and home health providers.

The substance of the conversations focused on beefing up program integrity enforcement to weed out bad actors in the space.

“[CMS] was hearing about [fraud] from a lot of different sources, and decided that it was time to go see what was happening on the ground,” Mollie Gurian, vice president of policy and government affairs for LeadingAge, told Home Health Care News’ sister publication, Hospice News.

Home health has been identified as a “prime target” for Medicare fraud, leading to increased actions to combat suspicious behavior among home health agencies.

Medicare Payment Advisory Commission (MedPAC), which recently voted to recommend a 7% cut to Medicare home health cuts, has identified “program integrity concerns” among home health agencies, specifically those in Los Angeles County, California – an area that has become the example of fraud in the home health space.

Home health industry stakeholders have called on CMS to root out home health fraud and to avoid using fraudulent or suspicious data in the methodology used to determine home health Medicare payments.

In Oz’s conversation with industry stakeholders, he specifically narrowed in on questions about physicians, Hilary Loeffler, vice president of policy and regulatory affairs for the Alliance, told Hospice News.

“It’s very hard for these schemes to be successful without involving physicians, and he was very interested in what it takes today to get a physician to compromise their ethics and their schooling to go along with these schemes,” Loeffler said. “He was very focused on the types of kickback arrangements that are going on. He was also very interested in the scope of the problem.”

Other key topics that were discussed included the following, according to Tom Koutsoumpas, founder and CEO of NPHI:

What providers are seeing on the ground
How fraudulent and abusive behavior manifests in real settings
How current oversight approaches affect high-performing providers
What information CMS needs to make informed policy and enforcement decisions
Better targeting audits and oversight toward behaviors indicative of fraud and abuse (high live discharge rates, failure to provide all four levels of care, etc.)
Avoiding unnecessary burden on high-quality, nonprofit providers
Using provider experience to inform more effective enforcement strategies
How aspects of the current hospice benefit structure may unintentionally invite fraudulent behavior
Potential reforms CMS could consider to strengthen program integrity while preserving access to high-quality care, including eligibility, payment, and quality outcomes.

Home health industry representatives and CMS leaders discussed the ways that fraud can skew payment rates.

“[CMS] does these calculations to try to figure out if they’re overpaying home health agencies under [[he Patient-Driven Groupings Model] that they put in place, and the way they do that is they reprice claims,” Loeffler said. “The issues in Los Angeles County really started surging in the past few years for home health. So if they’re trying to compare claims today and what they would have been paid in a pre-2020 scenario, there’s a bunch of what we think is sufficient billing patterns coming out of LA that we think are impacting the calculations. They’re including claims from Los Angeles County that skew their numbers.”

Oz also did a “ride-along” to see areas of Los Angeles County that were rife with fraudulent providers, often operating from the same address, Koutsompas told Hospice News. Following the meetings, Oz held a press conference in which he pledged to crack down on fraud. Days later, a group of congressional lawmakers wrote to CMS urging further action on these scams.

“We commend the administration for taking decisive action to confront fraud, waste and abuse in hospice care and for recognizing that strong program integrity is essential to ensuring patients and families receive the highest standard of care at one of the most vulnerable moments in their lives,” Koutsoumpas said in a statement emailed to Hospice News. “By coming, putting boots on the ground to see care delivered by a trusted nonprofit provider, CMS leadership is sending a clear message that protecting quality and access is the priority.”

Prior to the event, LeadingAge and the Alliance wrote to CMS with recommendations on ways to fight fraudulent operators.

The post Dr. Oz, CMS Leaders Visit Home Health Fraud Hot Spots appeared first on Home Health Care News.

Top Home Health Trends For 2026

Fri, 16 Jan 2026 21:48:16 +0000

This article is a part of your HHCN+ Membership

In 2025, Medicare-certified home health providers faced dramatic uncertainty. The Centers for Medicare and Medicaid Services (CMS) proposed the largest-ever cut to the Medicare home health payment rate, prompting an outcry from providers, workers and patients, with the ultimate result being a much less painful final rate cut.

While recovering from an anxiety-inducing 2025, home health providers have further complications on the horizon in 2026. The industry can expect additional layoffs after some high-profile rounds in 2025, and must contend with a novel type of mandatory payment model. Key pieces of legislation also stand to make or break aspects of the home health industry, specifically implicating the hospital-at-home market and the payvider trend.

In 2026, providers that focus on future-proofing their service lines and withstand pressures on care quality will have the opportunity to usher in the next era of home health care and become the center of health care’s shift into the home.

Curious what we forecasted for last year? Revisit our 2025 predictions here.

A year of layoffs

In the home health sector, the typical workforce story revolves around providers’ struggling to recruit and retain workers. But last year, layoffs generated notable headlines.

In June, home health care giant Bayada Home Health Care laid off 10% of its headquarters staff, citing a difficult reimbursement environment. In September, hospital-at-home leader DispatchHealth scaled back its operations in 10 markets, laying off employees in the process.

Other providers had to take similar measures as well.

“You can 10x an employee by amplifying them with technology, but the reality is, we did have to lay people off, just like a lot of other home health [companies] had to do,” Healthview CEO Steven Gonzalez previously told HHCN.

In 2026, providers have several opportunities to relieve some of the pressures that led to layoffs in 2025, notably through the use of efficiency-improving technologies. But with yet another Medicare home health rate cut to contend with and continuing workforce struggles, providers will increasingly be forced to minimize their workforce pool to save costs. The big-name providers in the headlines for layoffs in 2025 were just the first cracks in the ice that is now set to break.

Resisting ‘enshittification’

Home health providers are seeking to transform their operations to focus on efficiency, often leaning on new AI tools. Technology is no longer optional – these transformations are necessary for the industry to survive and continually shift the home into the center of the health care ecosystem.

However, providers in 2026 must ensure that patients receive a person-first, high-quality experience while still leveraging AI. If not, they risk entering the trap of “enshittification.” This term refers to a drop in quality within digital platforms – think the proliferation of AI content on Facebook that drowns out posts from a user’s actual friends.

Home health providers in 2026 will need to ensure that they prioritize AI tools without relying on automation so much that worker and patient experiences feel soulless. As operators move from focusing on back-office AI technology to more worker- and patient-focused tech, having strong AI quality control will be of paramount importance. As many provider executives have noted, AI – or technology of any kind – ideally should enable more meaningful human connections between caregivers and patients; glitches in the AI or ill-conceived use cases for it might be an unavoidable growing pain as the technology proliferates and evolves, but savvy providers will limit these negative effects.

That is, as early technology adopters will spend 2026 chasing the most cutting-edge technology, those seeking to maintain or improve worker and patient retention must wade into the waters of tech-first innovation with a nod toward old-school tactics: human touch.

Focusing on becoming a TEAM player

In 2026, many home health operators will have to contend with a new mandatory payment model – and those that are not implicated in the model will be paying close attention.

The Centers for Medicare and Medicaid Services’ (CMS) mandatory bundled Transforming Episode Accountability Model (TEAM) went into effect on Jan. 1, 2026, and is poised to propel the home health industry further into the world of alternative payment models because of its broad scope and clear pressure to send more patients into more affordable care settings.

Additionally, TEAM has a key distinction from other mandatory payment models: it compares providers to one another within a large region.

“Other bundled payment models have been historical provider price models, which means you just had to beat yourself from the past,” Brian Fuller, managing director of ATI Advisory’s value-based care design and delivery practice, previously told HHCN. “This is a regional target price model, which means you’ve got to be better than your region.”

In 2026, providers implicated by the model’s wide scope of 743 participating hospitals will have to contend with these regional competitions. To clearly communicate their value among their peers, providers will focus on analytics and compelling pitches to hospitals to make their value clear – and they must more than ever before leverage the right systems and processes for meaningful and aligned collaboration with hospital partners.

The end of the pure-play provider

In 2025, the home health industry rallied against a singular threat: the largest cut to the Medicare home health payment rate ever proposed.

While prioritizing advocacy work, providers hastened to plan for the worst-case scenario. Some considered scaling back their home health offerings to expand their focus on other service lines.

“If the rule truly does move forward with this 9% cut, there’s a possibility that we will be one of those agencies that just decides to go in a different direction and really pull back altogether on skilled home health care,” Empath Health CEO Jonathan Fleece previously told Home Health Care News. “Skilled home health already runs at an operating loss for many agencies. That’s one of the options on the table, is we would potentially be one of those skilled agencies that would repurpose home health, and focus on our core business of end-of-life care and the frail elderly.”

While the final rule included a much softer rate cut than initially proposed, it still reduced Medicare payments, making a compelling case for providers to focus on or expand into areas of their businesses with less frequent cuts.

Additionally, the fear that providers felt in 2025 will not be easily forgotten and will spur providers to turn to services like hospice care to manage reimbursement risk through diversification.

Hospital-at-home atrophy sets in

Hospital-at-home services are widely seen as a promising way to drive health care costs down while meeting patients in their preferred setting – and that promise has spurred notable innovation and investment. However, the promise of hospital-at-home has yet to be fully realized, as regulatory limbo has relegated this model to wait-and-see status – the Acute Hospital Care at Home waiver program has been kept on life support by a series of short-term extensions, making investments in the space risky.

Legislators have an opportunity to pass the Hospital Inpatient Services Modernization Act, which would extend the waiver program for five years – but time is running out to do so. The program is currently set to expire on Jan. 30, along with other telehealth measures.

But with a long history of short-term extensions, even historically bipartisan support for hospital-at-home services may not be enough to give the waiver program the attention it deserves from lawmakers to get the bill across the finish line by the deadline.

And the industry has already witnessed fallout from waiver uncertainty. Inbound Health, a hospital-at-home enablement platform that had garnered over $50 million in investment dollars, shut down at the end of November, citing regulatory uncertainty.

The fact that such a well-funded operation failed to identify a path forward signals just how urgently this part of the at-home care market needs greater certainty and security. With that unlikely to happen in 2026, the hospital-at-home sector is likely to atrophy; while some well-capitalized players will hold steady, innovation will stall, growth will slow or reverse, and a future in which hospital-at-home is fulfilling its potential will become more distant .

Blocking vertical vision

In 2025, one of the top news pegs was the completion of the long-fought UnitedHealth Group (NYSE: UNH)/Amedysis deal. This acquisition exemplifies a years-long trend of increasing vertical integration in the industry – but this trend is set to change in 2026.

When President Donald Trump took office, there was a widely held belief that the UnitedHealth deal would go through, and that would unlock further major consolidation in the home health space during a period of more relaxed antitrust enforcement. But, despite the UnitedHealth deal crossing the finish line, that is not likely to happen in 2026. So-called payviders find themselves under increasing political pressure and facing more public skepticism and media criticism.

A bill proposed in September, the Patients Over Profits Act, is set to prohibit insurers from purchasing Medicare home health providers. If passed, it would stop companies like UnitedHealth from acquiring health care providers that are reimbursed through Medicare Part B or Part C.

“Breaking up UnitedHealth’s insurance and physician businesses is the first step toward building something better, where every American is able to get the care they deserve at a price they can afford,” one of the bill’s sponsors, Rep. Pat Ryan (D-N.Y.), said.

This is not the first time lawmakers have taken aim at vertical integration. Mega-payviders have come under fire for using their provider arms to inflate care prices and skirt federal regulations, prompting calls for the Department of Health and Human Services (HHS) Office of Inspector General (OIG) to evaluate vertical integration’s impact on costs and payviders’ ability to evade requirements.

Rather than the year of rapid vertical expansion that might have been expected under the Trump presidency, the home health industry can expect 2026 to be a year of retrenchment – particularly if the Democrats gain power in Congress in the midterms. Vertical integration will not stop, but it will slow.

The post Top Home Health Trends For 2026 appeared first on Home Health Care News.

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