Electronic Visit Verification is mandatory for Medicaid-funded home care under the 21st Century Cures Act — personal care since 2020, home health since 2023. Every credible platform is compliant; what differs is the aggregator relationship. HHAeXchange leads as the aggregator of record in several states; AlayaCare leads for EVV inside an integrated platform; AxisCare leads for optional non-Medicaid EVV.
Under the 21st Century Cures Act, EVV is required for all Medicaid-funded personal care services (since January 2020) and home health services (since January 2023). Those mandates are fully in force in 2026. EVV must capture six data points: the type of service, the individual receiving it, the date, the location, the individual providing it, and the time it begins and ends.
The practical question isn’t whether a platform is compliant — they all are — but whether it functions as your state’s aggregator or submits to one. HHAeXchange serves as the aggregator in several states; AlayaCare and AxisCare are compliant and submit to the state aggregator.
Functions as the state EVV aggregator in New York, New Jersey, Illinois, and others — the deepest EVV integration available.
Compliant EVV inside a modern multi-service cloud platform — strong when EVV is one requirement among many.
Cures Act–compliant EVV for non-medical agencies that want caregiver accountability without Medicaid complexity.
HHAeXchange is the EVV vendor of record for many state Medicaid programs. Where it serves as the aggregator, your EVV data flows through it to the state — there’s no deeper EVV integration available. For Medicaid-heavy agencies in those states, the EVV decision is effectively made for you, and HHAeXchange is the answer.
AlayaCare delivers compliant EVV inside a modern platform that also handles scheduling, billing, and multi-service workflows. It submits to state aggregators rather than serving as one, so in HHAeXchange-mandated states it often complements rather than replaces. For agencies where EVV is one of many requirements, the integrated approach is appealing.
AxisCare’s EVV is Cures Act–compliant and integrates with state aggregators where required. Its sweet spot is non-medical agencies that want EVV for accountability and proof of service — including on private-pay visits, where EVV is optional but valuable. Simple, compliant, and not overbuilt.
| HHAeXchange | AlayaCare | AxisCare | |
|---|---|---|---|
| Founded | 2008 | 2014 | 2011 |
| HQ | New York, NY | Montreal, QC | Waco, TX |
| Focus | Medicaid home care, HHA workflow, EVV compliance | Home care + home health + community care; cloud-native | Non-medical home care (personal care, companion care) |
| Best for | Medicaid-heavy agencies, multi-state Medicaid, EVV-driven | Tech-forward mid-market to enterprise, multi-service agencies | Non-medical agencies, 10–250 caregivers, mid-market growth |
| Install base | ~700,000 caregivers across 6,000+ agencies | ~800+ agencies | ~5,000+ agencies |
| Pricing model | Per-billable-hour + monthly fee | Per module + per user | Per active caregiver |
| Mid-market spend | Varies widely by state Medicaid contract | ~$1,000–3,000/mo | ~$300–600/mo (50 caregivers) |
| EVV compliant | Yes | Yes | Yes |
| Caregiver app | iOS + Android | iOS + Android | iOS + Android |
| Analytics | Medicaid + EVV-focused | Advanced (Visit Optimizer AI) | Standard reporting |
| Integration ecosystem | State Medicaid + payer integrations | API + iCarol (acquired call center) | API + select partners |
| Implementation | 8–16 weeks | 6–16 weeks | 2–6 weeks |
| HeyHomeCare integration | Native API | Deep native API | Native API |
EVV compliance isn’t only about having the right platform — it’s about catching the missed clock-in in time. In many states, a clock-in that lands after the penalty window can mean a denied Medicaid reimbursement. The platform records the miss; it doesn’t chase it down.
HeyHomeCare does. It reads your live schedule and EVV flags, recognizes when a clock-in is overdue, and reaches the caregiver immediately — confirming they’re on-site or rerouting before the window closes. It reads EVV-adjacent data but does not submit EVV records; submission stays with HHAeXchange or your platform of record.
HeyHomeCare detects missed clock-ins and reaches the caregiver before the penalty window closes — cutting denied reimbursement. It reads EVV flags but never submits EVV records; that stays with your platform.