For Medicaid home care in 2026, HHAeXchange is the default pick — in several states it functions as the EVV aggregator itself. AlayaCare is the strongest multi-service Medicaid option, and Axxess Home Care fits agencies mixing Medicaid with skilled care. EVV compliance under the 21st Century Cures Act is table stakes; the real decision is about state fit and payer mix.
Electronic Visit Verification has been mandatory for Medicaid-funded personal care services since 2020 and home health since 2023, under the 21st Century Cures Act. That requirement is firmly in force in 2026, and every credible Medicaid platform is compliant. What differs is the aggregator relationship.
In several states, HHAeXchange functions as the state EVV aggregator — the system Medicaid data flows through — rather than just submitting to one. AlayaCare and Axxess are EVV-compliant but submit to aggregators rather than serving as one. Which aggregator your state mandates often makes the platform decision for you on the Medicaid side.
The dominant Medicaid platform and the EVV aggregator of record in several states. The default for any Medicaid-majority agency.
Cloud-native, unifies home care + home health + community — the pick when Medicaid spans multiple service lines.
Many agencies run HHAeXchange for Medicaid and AxisCare for the private-pay book until consolidation makes sense.
HHAeXchange is the Medicaid leader — around 700,000 caregivers across 6,000+ agencies, and in states like New York, New Jersey, and Illinois it’s woven directly into the Medicaid EVV program. Its payer-provider connectivity and EVV depth are unmatched for Medicaid work. The UI is more dated and configuration more complex than the modern platforms, but for a Medicaid-majority agency that’s a worthwhile trade.
AlayaCare is the multi-service Medicaid pick. It’s EVV-compliant and unifies home care, home health, and community care in one modern cloud platform — useful when your Medicaid book spans service lines. Its state-aggregator integrations aren’t as deep as HHAeXchange’s, so in HHAeXchange-mandated states it’s often a complement rather than a replacement.
Axxess Home Care suits agencies mixing Medicaid non-medical with skilled care. Its clinical-compliance strength (OASIS-E, PDGM) is the draw for agencies that also run home health, and its Home Care module handles Medicaid personal care. It’s heavier than HHAeXchange for pure Medicaid PCS work, but consolidates clinical and non-medical under one vendor.
| HHAeXchange | AlayaCare | Axxess | |
|---|---|---|---|
| Founded | 2008 | 2014 | 2007 |
| HQ | New York, NY | Montreal, QC | Dallas, TX |
| Focus | Medicaid home care, HHA workflow, EVV compliance | Home care + home health + community care; cloud-native | Home Health, Hospice, Palliative Care, Home Care (multi-product suite) |
| Best for | Medicaid-heavy agencies, multi-state Medicaid, EVV-driven | Tech-forward mid-market to enterprise, multi-service agencies | Skilled-care agencies, mixed home health + hospice + home care |
| Install base | ~700,000 caregivers across 6,000+ agencies | ~800+ agencies | ~9,000+ agencies |
| Pricing model | Per-billable-hour + monthly fee | Per module + per user | Per user / per patient-census |
| Mid-market spend | Varies widely by state Medicaid contract | ~$1,000–3,000/mo | Enterprise; published rates rare |
| EVV compliant | Yes | Yes | Yes |
| Caregiver app | iOS + Android | iOS + Android | iOS + Android |
| Analytics | Medicaid + EVV-focused | Advanced (Visit Optimizer AI) | Deep clinical reporting |
| Integration ecosystem | State Medicaid + payer integrations | API + iCarol (acquired call center) | API + integration partners |
| Implementation | 8–16 weeks | 6–16 weeks | 8–16 weeks |
| HeyHomeCare integration | Native API | Deep native API | Native API |
Medicaid home care isn’t one market — it’s 50, each with its own EVV aggregator and contract rules. A few that shape the platform decision:
In a Medicaid book, a missed clock-in isn’t just an operational annoyance — past the penalty window it can mean a denied reimbursement. That’s the gap HeyHomeCare fills. It reads your live schedule and EVV flags, recognizes when a clock-in is overdue, and reaches the caregiver immediately to protect the visit.
Importantly, HeyHomeCare reads EVV-adjacent data but does not submit EVV records — that stays with HHAeXchange or your platform of record. It’s the AI inbound layer, not a replacement EVV system.
HeyHomeCare handles Medicaid caregiver inbound with EVV-aware routing — it chases missed clock-ins before penalty windows expire, protecting your reimbursement. Native HHAeXchange integration.