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Significant Payors | 12 Months Ended
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Dec. 31, 2021
Significant Payors [Abstract] |
Significant Payors | 14. Significant Payors For 2021, 2020 and 2019, the Company’s revenue by payor type was as follows:
|  | Personal Care |  |
|  | For the Years Ended December 31, |  |
|  | 2021 |  |  |  | 2020 |  |  |  | 2019 |  |
|  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |
State, local and other governmental programs |  | $ | 338,325 |  |  |  | 49.3 |  | % |  | $ | 324,670 |  |  |  | 50.2 |  | % |  | $ | 303,479 |  |  |  | 52.2 |  | %
Managed care organizations |  |  | 311,801 |  |  |  | 45.5 |  |  |  |  | 287,032 |  |  |  | 44.3 |  |  |  |  | 239,559 |  |  |  | 41.3 |  |
Private pay |  |  | 19,991 |  |  |  | 2.9 |  |  |  |  | 20,398 |  |  |  | 3.2 |  |  |  |  | 21,765 |  |  |  | 3.7 |  |
Commercial insurance |  |  | 9,820 |  |  |  | 1.4 |  |  |  |  | 9,991 |  |  |  | 1.5 |  |  |  |  | 9,204 |  |  |  | 1.6 |  |
Other |  |  | 5,917 |  |  |  | 0.9 |  |  |  |  | 5,142 |  |  |  | 0.8 |  |  |  |  | 6,721 |  |  |  | 1.2 |  |
Total personal care segment net service revenues |  | $ | 685,854 |  |  |  | 100.0 |  | % |  | $ | 647,233 |  |  |  | 100.0 |  | % |  | $ | 580,728 |  |  |  | 100.0 |  | %
|  | Hospice |  |
|  | For the Years Ended December 31, |  |
|  | 2021 |  |  |  | 2020 |  |  |  | 2019 |  |
|  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |
Medicare |  | $ | 142,086 |  |  |  | 93.3 |  | % |  | $ | 94,068 |  |  |  | 92.9 |  | % |  | $ | 49,649 |  |  |  | 92.6 |  | %
Managed care organizations |  |  | 5,664 |  |  |  | 3.7 |  |  |  |  | 4,931 |  |  |  | 4.9 |  |  |  |  | 2,768 |  |  |  | 5.2 |  |
Other |  |  | 4,503 |  |  |  | 3.0 |  |  |  |  | 2,298 |  |  |  | 2.2 |  |  |  |  | 1,184 |  |  |  | 2.2 |  |
Total hospice segment net service revenues |  | $ | 152,253 |  |  |  | 100.0 |  | % |  | $ | 101,297 |  |  |  | 100.0 |  | % |  | $ | 53,601 |  |  |  | 100.0 |  | %
|  | Home Health |  |
|  | For the Years Ended December 31, |  |
|  | 2021 |  |  |  | 2020 |  |  |  | 2019 |  |
|  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |
Medicare |  | $ | 20,700 |  |  |  | 78.4 |  | % |  | $ | 12,765 |  |  |  | 78.6 |  | % |  | $ | 11,218 |  |  |  | 77.6 |  | %
Managed care organizations |  |  | 4,457 |  |  |  | 16.9 |  |  |  |  | 3,188 |  |  |  | 19.6 |  |  |  |  | 2,942 |  |  |  | 20.3 |  |
Other |  |  | 1,235 |  |  |  | 4.7 |  |  |  |  | 292 |  |  |  | 1.8 |  |  |  |  | 302 |  |  |  | 2.1 |  |
Total home health segment net service revenues |  | $ | 26,392 |  |  |  | 100.0 |  | % |  | $ | 16,245 |  |  |  | 100.0 |  | % |  | $ | 14,462 |  |  |  | 100.0 |  | %
The Company derives a significant amount of its revenue from its operations in Illinois, New Mexico and New York. The percentages of segment revenue for each of these significant states for 2021, 2020 and 2019 were as follows:
|  | Personal Care |  |
|  | For the Years Ended December 31, |  |
|  | 2021 |  |  |  | 2020 |  |  |  | 2019 |  |
|  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |
Illinois |  | $ | 328,619 |  |  |  | 47.9 |  | % |  | $ | 288,326 |  |  |  | 44.6 |  | % |  | $ | 247,524 |  |  |  | 42.6 |  | %
New York |  |  | 99,732 |  |  |  | 14.5 |  |  |  |  | 115,510 |  |  |  | 17.8 |  |  |  |  | 108,403 |  |  |  | 18.7 |  |
New Mexico |  |  | 97,784 |  |  |  | 14.3 |  |  |  |  | 86,618 |  |  |  | 13.4 |  |  |  |  | 75,666 |  |  |  | 13.0 |  |
All other states |  |  | 159,719 |  |  |  | 23.3 |  |  |  |  | 156,779 |  |  |  | 24.2 |  |  |  |  | 149,135 |  |  |  | 25.7 |  |
Total personal care segment net service revenues |  | $ | 685,854 |  |  |  | 100.0 |  | % |  | $ | 647,233 |  |  |  | 100.0 |  | % |  | $ | 580,728 |  |  |  | 100.0 |  | %
|  | Hospice |  |
|  | For the Years Ended December 31, |  |
|  | 2021 |  |  |  | 2020 |  |  |  | 2019 |  |
|  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |
Ohio |  | $ | 61,415 |  |  |  | 40.3 |  | % |  | $ | — |  |  |  | — |  | % |  | $ | — |  |  |  | — |  | %
New Mexico |  |  | 36,063 |  |  |  | 23.7 |  |  |  |  | 42,648 |  |  |  | 42.1 |  |  |  |  | 38,790 |  |  |  | 72.4 |  |
All other states |  |  | 54,775 |  |  |  | 36.0 |  |  |  |  | 58,649 |  |  |  | 57.9 |  |  |  |  | 14,811 |  |  |  | 27.6 |  |
Total hospice segment net service revenues |  | $ | 152,253 |  |  |  | 100.0 |  | % |  | $ | 101,297 |  |  |  | 100.0 |  | % |  | $ | 53,601 |  |  |  | 100.0 |  | %
With the acquisition of Queen City Hospice, the Company expanded its hospice services in the state of Ohio.
|  | Home Health |  |
|  | For the Years Ended December 31, |  |
|  | 2021 |  |  |  | 2020 |  |  |  | 2019 |  |
|  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |  |  | Amount (in Thousands) |  |  | % of Segment Net Service Revenues |  |
New Mexico |  | $ | 24,735 |  |  |  | 93.7 |  | % |  | $ | 16,245 |  |  |  | 100.0 |  | % |  | $ | 14,462 |  |  |  | 100.0 |  | %
Illinois |  |  | 1,657 |  |  |  | 6.3 |  |  |  |  | — |  |  |  | — |  |  |  |  | — |  |  |  | — |  |
Total home health segment net service revenues |  | $ | 26,392 |  |  |  | 100.0 |  | % |  | $ | 16,245 |  |  |  | 100.0 |  | % |  | $ | 14,462 |  |  |  | 100.0 |  | %
With the acquisition of Summit, the Company expanded its home health services in the state of Illinois. A substantial portion of the Company’s revenue and accounts receivable are derived from services performed for state and local governmental agencies. We derive a significant amount of our net service revenues in Illinois, which represented 38.2%, 37.7% and 38.2% of our net service revenues for the years ended December 31, 2021, 2020 and 2019, respectively. The Illinois Department on Aging, the largest payor program for the Company’s Illinois personal care operations, accounted for 21.4%, 23.0% and 25.3% of the Company’s net service revenues for 2021, 2020 and 2019, respectively. The related receivables due from the Illinois Department on Aging represented 16.1% and 15.9% of the Company’s net accounts receivable at December 31, 2021 and 2020, respectively. In 2019, New York initiated a new Request For Offer (“RFO”) process to competitively procure CDPAP fiscal intermediaries. The Company was not selected in the initial RFO process. We submitted a formal protest in response to the selection process, which was filed and accepted in March 2021, but have not yet received a response to the formal protest. The Company recognized approximately $42 million and $3 million in net service revenue and operating income, respectively, from the program for the year ended December 31, 2021. The New York fiscal year 2022 state budget included a provision to add additional fiscal intermediaries (one or two entities per county with specified population sizes, plus entities that meet various other requirements) to those awarded contracts as a Lead Fiscal Intermediary under the initial RFO process, based on the scoring of the original RFO. As scoring of RFOs was not publicly released, it is unknown at this time if the Company’s score ranked high enough to qualify for these additional awards. The Company has submitted a response to the survey issued by the New York Department of Health to determine the additional contract awards. The New York Department of Health published an anticipated contract start date for all awards to be no earlier than November 1, 2021, but has not yet announced the exact start date. No later than the contract start date, we will be required to begin transitioning patients within the CDPAP to a fiscal intermediary that has been awarded a contract and cease providing services to those patients. The Company continues to consider other arrangements and to pursue our protest of the award. Given the uncertainty surrounding the program, the Company has suspended materially all of its new patient admissions under the New York CDPAP program.

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