Home and community-based healthcare providers, including home healthcare, hospice, and behavioral health agencies, are entering a period of significant opportunity. At the same time, sustaining service continuity and quality amid rapid growth is creating substantial financial strain. To ensure they can keep pace with rising demand, these providers need reliable access to working capital to support expansion, stabilize operations, and safeguard the delivery of high-quality care.
This article reviews the current state of home and community-based care and presents 2026 projections showing continued strong growth. It examines the financial pressures facing agencies in expansion mode and illustrates how flexible specialty financing can help providers fund growth and maintain service continuity.
The current state of home and community-based care
Demand for home and community-based healthcare services, including home healthcare, hospice, and behavioral health, continues to grow as aging populations, consumer preferences, and value-based care models shift treatment outside of traditional facilities. Across the nation, healthcare systems, insurers, and policymakers are prioritizing home and community-based interventions to reduce hospitalization, improve outcomes, and lower the total cost of care.
As a result, utilization of these services has increased steadily since 2022 and is expected to continue rising into 2026.
Industry projections
Looking ahead, demand for home and community-based care is expected to continue rising through 2026 and beyond. Several macro trends are driving this expansion:
An aging population: By 2026, more than 70 million Americans will be age 65 or older. The majority prefer to receive care in their homes or in community-based settings, especially as hospitals and long-term care facilities face capacity constraints and staffing challenges.
Shift toward value-based care: Payers are increasingly incentivizing models that emphasize preventive, home and community-based care. This shift accelerates referrals to home health, hospice, behavioral health, and other community-based agencies.
Hospital capacity constraints: Labor shortages, rising operating costs, and high patient volume in acute care facilities are driving more care into home and community-based settings, reducing hospital readmissions and preserving capacity.
However, the benefits of high demand are tempered by persistent financial pressures:
Thin margins: Home and community-based healthcare providers typically operate with margins of 2% to 8%, substantially lower than hospitals or skilled nursing facilities. These providers face labor-intensive operations, lower reimbursement rates, administrative complexity, and limited ability to achieve economies of scale.
Reimbursement Delays: A significant financial challenge these operators face is that Medicare, Medicaid, and commercial insurers continue to delay payment, often beyond 60, 90, or 120 days. For providers operating on thin margins and minimal cash reserves, reimbursement delays create significant cash flow gaps.
Rising operational demands: To continue delivering high-quality care, home and community-based providers must:
- Offer competitive wages, training, and incentives to recruit and retain skilled nurses, aides, therapists, and behavioral health specialists.
- Manage rising operational expenses across nearly every category: transportation, medical supplies, digital platforms, cybersecurity, credentialing, and administrative overhead.
- Ensure compliance with evolving value-based care and digital reporting requirements. Agencies are spending more time, resources, and capital to maintain quality metrics, billing rules, and performance standards.
Even with these challenges, growth is essential. Expanding services and scaling operations can strengthen financial stability, enhance competitiveness, and enable providers to meet the rising demand for home and community-based care.
Financial pressures facing providers in growth mode
Growth is essential for long-term success in home and community-based care. Providers must expand services, hire staff, and invest in infrastructure to keep pace with rising demand, or risk falling behind competitors. However, growth comes with significant financial pressures, particularly for organizations operating with thin margins and limited cash reserves.
Typical growth-related costs include:
- Hiring and training clinicians, aides, therapists, and behavioral health specialists.
- Expanding administrative teams, such as schedulers, quality reviewers, and compliance staff.
- Transportation expenses, including vehicles, mileage reimbursements, and travel stipends.
- Technology investments, such as electronic health record (HER) upgrades, telehealth, and remote monitoring tools.
- Credentialing, licensing, and accreditation fees.
- Marketing, referral development, and community outreach to drive new patient volume.
Because many of these costs are upfront, limited access to working capital typically hinders the ability to self-fund growth. Agencies with constrained liquidity may delay or decline referrals, limit service expansion into high-demand areas, or postpone essential technology upgrades, all of which affect patient care and revenue potential.
At the heart of these challenges is a prolonged cash flow cycle driven by delayed reimbursements from Medicare, Medicaid, and commercial insurers. Without flexible financing solutions, even well-managed providers risk operational strain, missed growth opportunities, and impacts on patient care quality.
Flexible, responsive cash flow solutions
The combination of rapid growth and tight margins highlights the need for flexible, responsive financing that supports day-to-day operations while enabling expansion.
While traditional lenders are often conservative and slow, fintech specialty lenders focused on healthcare are breaking new ground with innovative funding options.
Two of the most effective tools for home and community-based care providers are healthcare receivables financing and asset-based lending (ABL). These solutions help organizations maintain liquidity, ensure high-quality care, and fund strategic growth.
Essential cash flow solutions to support liquidity and growth
- Healthcare receivables financing allows providers to unlock cash tied up in outstanding claims from Medicare, Medicaid, and commercial insurers. Instead of waiting months for reimbursement, organizations can convert receivables into working capital within days.
Key Benefits for Home and Community-Based Care Providers:
- Predictable cash flow to cover payroll and recruit staff.
- Funding for new service lines, including home-based primary care, behavioral health, and palliative care.
- Liquidity for technology investments, such as EHR upgrades, telehealth platforms, and remote monitoring.
- Stability during reimbursement delays and seasonal fluctuations.
- Stronger cash position for managing compliance, documentation, and reporting demands.
Leading specialty lenders often offer value-added services such as claim verification, billing support, and collections management. Receivables financing is especially powerful for growing agencies because funding expands as receivables increase, making it a natural fit for fast-growing organizations.
- Asset-based lending provides a revolving credit facility secured by receivables, inventory, equipment, or other assets. ABL is ideal for agencies preparing for significant growth initiatives.
ABL Supports:
- Large-scale hiring initiatives or onboarding new clinical teams.
- Service diversification, including behavioral health, palliative care, and chronic disease programs.
- Acquisitions or geographic expansion.
- Modernization of technology, including interoperability upgrades, scheduling systems, and digital care tools.
- Working capital reserves that protect the continuity of care during reimbursement delays.
ABL offers flexibility and scalability, avoiding the rigid covenants typical of traditional bank loans. It is specifically structured to accommodate complex healthcare billing cycles, government reimbursements, and Medicare/Medicaid payment timelines, making it a natural fit for home and community-based care providers.
Case study spotlight
A self-funded Ohio hospice and palliative care provider faced cash flow strain and limited flexibility, creating risk to ongoing operations and service continuity. eCapital provided a $3MM healthcare receivables line of credit secured by outstanding claims, increasing access to working capital to support payroll, operations, and growth.
Conclusion
The future of healthcare is increasingly home and community-centred. Providers offering home-based care, hospice, or behavioral health services are well-positioned for long-term growth, but only if they have the financial resilience to manage rising costs, reimbursement delays, and workforce challenges.
For many providers, cash flow, not demand, is often the primary constraint on growth.
Flexible funding solutions, such as Healthcare receivables financing and ABL, give providers the predictable, scalable liquidity needed to support expansion, stabilize operations, and maintain high-quality patient care. With the right funding strategy, organizations can invest in technology, build clinical capacity, open new service lines, and confidently navigate the financial complexities of 2026.
Home and community-based care is on the rise – and with the proper financial tools in place, providers can seize the opportunity to grow, innovate, and continue delivering essential care where patients need it most: at home.
Contact us to unlock fast, flexible working capital and keep your home-health agency growing strong despite the strain of delayed reimbursements.
Key Takeaways
- Home and community-based healthcare utilization has increased steadily since 2022. Analysts expect demand for home-based care to continue rising into 2026 and beyond.
- However, the benefits of high demand are offset by the constraints of slim margins and slow reimbursements which typically create debilitating cash flow gaps.
- Growth is essential to enhance financial stability and expand services to remain competitive in an increasingly complex healthcare landscape.
- Flexible, responsive cash flow solutions offer providers the predictable, flexible liquidity needed to support expansion, stabilize operations, and maintain high-quality patient care.
ABOUT eCapital
At eCapital, we accelerate business growth by delivering fast, flexible access to capital through cutting-edge technology and deep industry insight.
Across North America and the U.K., we’ve redefined how small and medium-sized businesses access funding—eliminating friction, speeding approvals, and empowering clients with access to the capital they need to move forward. With the capacity to fund facilities from $5 million to $250 million, we support a wide range of business needs at every stage.
With a powerful blend of innovation, scalability, and personalized service, we’re not just a funding provider, we’re a strategic partner built for what’s next.
