The Republican-led House passed the “One Big Beautiful Bill Act” on May 22, 2025, by a vote of 215-214, and it has moved to the Senate for consideration. Whatever its final form, the budget bill could bring reforms that will challenge home health providers to evolve and adapt as they could face reduced funding and patient access. The LevinPro HC team sat down with Al Veach, CEO of Agenda Health, one of the most active M&A advisory firms in the home health sector, according to LevinPro HC data. Veach offered insights on navigating this landscape, as Senate debates continue to shape the bill’s future.
Veach first emphasized the potential benefits of the bill’s Medicaid cuts, which could revamp a system that has been losing credibility lately due to persistent fraud concerns, as noted in recent Government Accountability Office reports. With this new bill, Veach sees an opening for reform, even if the short-term pain is real.
“You could say cuts are cuts, and less funding means less money going into the program. But the good side is it enables the government to focus on eligible patients with legitimate need and maybe even expand care for them where needed,” Veach said.
The bill outlines sweeping reductions: nearly $700 billion from Medicaid over the next decade, and a $45 billion cut to Medicare beginning in 2026. Alongside those cuts, it proposes new work requirements for Medicaid recipients, an idea that, in Veach’s view, reinforces the core mission of the program.
“Medicaid is a hand up, not a handout,” Veach noted. “If people see Medicaid as a source of income instead of something to help them get on their feet, the program will drown in itself. Able-bodied people need to try to earn income, even if it’s volunteer work, which I love seeing incorporated.”
Critics have mounted concerns about the potential for increased administrative burden and reduced access, but Veach believes a more selective system could, paradoxically, lead to stronger outcomes and greater public support. He argues that clear eligibility standards and consistent enforcement can bolster trust in public programs by reassuring voters that the system is being used as intended.
“Any program that functions efficiently and effectively, like Medicaid, will gain more public support. Voters back that,” he said. “It’s when the same person poses as multiple different people or non-citizens receive benefits that it falters.”
Veach also sees competitive pressure playing a positive role if eligibility narrows. A smaller patient pool could push providers to focus more on service quality, while phasing out unethical practices like paying for referrals, which according to Veach is a persistent issue.
“If you shorten the list of people who can receive service, you’ll increase the competitive nature,” he said. “Hopefully, that results in providers focusing more on quality. Necessity is the mother of invention.”
For Veach, that mindset shapes how he evaluates potential deals in the home health sector. Ethical rigor and mission alignment matter just as much as financial performance. Going forward, providers will need to pay close attention to how they screen and manage their patient base, especially in light of increasing scrutiny around Medicaid eligibility. Questions about citizenship verification or documentation standards aren’t just political now, they’re operational.
“In due diligence, you need to ask about patients, are you validating that they’re citizens? Is that part of your process?” Veach said. “Quality home health businesses come from quality operators… I’m looking for owners in it for more than just making money.”
Nearly every home health operator has a story and a personal mission, often shaped by their own experiences, that drive their work caring for aging seniors or supporting families in need, Veach explained. That deep sense of purpose is what makes the industry a compelling investment, even with legislative uncertainty looming.
“I’ve always said home health is unique,” Veach said. “What excites me is that many providers have a calling, a mission, a legacy they want to build. That’s what makes selling home health special compared to other businesses.”
As the Senate debates the bill’s future in the coming weeks, with a vote expected in June 2025, home health providers face a pivotal moment. The reforms will demand leaner operations and sharper focus, but Veach believes the industry’s mission-driven core will fuel innovation. By embracing competition and technology, operators can not only survive but redefine what home health means, delivering better care with fewer resources to the people who need it most.
