Significant Payors

9 Months Ended

Sep. 30, 2022

12. Significant Payors

The Company’s revenue by payor type was as follows:


Personal Care Segment		For the Three Months Ended September 30,								For the Nine Months Ended September 30,
	2022					2021				2022				2021
	Amount (in Thousands)		% of Segment Net Service Revenues		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	$	88,448	49.4	%	$	83,821	49.5	%	$	257,817	49.4	%	$	253,052	49.5	%
Managed care organizations		83,199	46.4			76,890	45.3			241,164	46.1			231,211	45.3
Private pay		4,521	2.6			4,934	2.9			13,758	2.6			14,883	2.9
Commercial insurance		1,870	1.0			2,459	1.4			5,988	1.1			7,481	1.5
Other		1,142	0.6			1,505	0.9			4,415	0.8			4,117	0.8
Total personal care segment net service revenues	$	179,180	100.0	%	$	169,609	100.0	%	$	523,142	100.0	%	$	510,744	100.0	%


Hospice Segment		For the Three Months Ended September 30,								For the Nine Months Ended September 30,
	2022					2021				2022				2021
	Amount (in Thousands)		% of Segment Net Service Revenues		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	$	46,537	90.6	%	$	36,280	92.7	%	$	137,174	90.8	%	$	104,715	93.4	%
Commercial insurance		2,772	5.4			1,154	3.0			7,742	5.1			2,648	2.4
Managed care organizations		1,815	3.5			1,514	3.9			5,498	3.6			4,396	3.9
Other		235	0.5			147	0.4			746	0.5			339	0.3
Total hospice segment net service revenues	$	51,359	100.0	%	$	39,095	100.0	%	$	151,160	100.0	%	$	112,098	100.0	%


Home Health Segment		For the Three Months Ended September 30,								For the Nine Months Ended September 30,
	2022					2021				2022				2021
	Amount (in Thousands)		% of Segment Net Service Revenues		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	$	7,320	73.5	%	$	6,372	80.1	%	$	21,727	73.0	%	$	13,699	80.5	%
Managed care organizations		1,998	20.1			1,218	15.3			6,160	20.7			2,838	16.7
Other		638	6.4			368	4.6			1,881	6.3			478	2.8
Total home health segment net service revenues	$	9,956	100.0	%	$	7,958	100.0	%	$	29,768	100.0	%	$	17,015	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 were as follows:


Personal Care Segment		For the Three Months Ended September 30,								For the Nine Months Ended September 30,
		2022				2021				2022				2021
	Amount (in Thousands)		% of Segment Net Service Revenues		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	$	92,804	51.8	%	$	81,959	48.3	%	$	266,284	50.9	%	$	240,131	47.0	%
New Mexico		26,912	15.0			24,214	14.3			78,825	15.1			73,291	14.3
New York (1)		20,997	11.7			24,127	14.2			63,510	12.1			77,237	15.1
All other states		38,467	21.5			39,309	23.2			114,523	21.9			120,085	23.6
Total personal care segment net service revenues	$	179,180	100.0	%	$	169,609	100.0	%	$	523,142	100.0	%	$	510,744	100.0	%

(1)

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 we have not received a response to the formal protest. The Company continues to consider other arrangements and to pursue our protest of the award. The New York fiscal year 2023 state budget, passed in April 2022, amends the current Fiscal Intermediary RFO process to authorize all fiscal intermediaries that submitted an RFO application and served at least 200 clients in New York City or 50 clients in other counties between January 1, 2020 and March 31, 2020 to contract with the New York State Department of Health and continue to operate in all counties contained in their application, if the fiscal intermediary submits an attestation and supporting information to the New York State Department of Health no later than November 29, 2022. Under this provision, the Company is allowed to continue to contract with all of its current payors for CDPAP services, as of the contract award date, which is anticipated to be January 15, 2023. The Company continues to assess the future of its participation in this program. Given the status of the program, the Company has suspended materially all of its new patient admissions under the New York CDPAP program.


Hospice Segment		For the Three Months Ended September 30,								For the Nine Months Ended September 30,
	2022					2021				2022				2021
	Amount (in Thousands)		% of Segment Net Service Revenues		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	$	18,139	35.3	%	$	15,868	40.6	%	$	51,714	34.2	%	$	44,676	39.8	%
Illinois (2)		12,188	23.7			—	—			35,290	23.3			—	—
New Mexico		7,789	15.2			9,268	23.7			23,867	15.8			27,216	24.3
All other states		13,243	25.8			13,959	35.7			40,289	26.7			40,206	35.9
Total hospice segment net service revenues	$	51,359	100.0	%	$	39,095	100.0	%	$	151,160	100.0	%	$	112,098	100.0	%

(2)

With the JourneyCare acquisition, the Company expanded its hospice services in the state of Illinois.


Home Health Segment		For the Three Months Ended September 30,								For the Nine Months Ended September 30,
	2022					2021				2022				2021
	Amount (in Thousands)		% of Segment Net Service Revenues		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	$	8,375	84.1	%	$	7,958	100.0	%	$	24,954	83.8	%	$	17,015	100.0	%
Illinois (3)		1,581	15.9			—	—			4,814	16.2			—	—
Total home health segment net service revenues	$	9,956	100.0	%	$	7,958	100.0	%	$	29,768	100.0	%	$	17,015	100.0	%

(3)

With the acquisition of Summit Home Health, LLC (“Summit”) on October 1, 2021, 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 federal, state and local governmental agencies. We derive a significant amount of our net service revenues in Illinois, which represented 44.3%, and 37.8% of our net service revenues for the three months ended September 30, 2022, and 2021, respectively, and accounted for 43.5% and 37.5% of our net service revenues for the nine months ended September 30, 2022 and 2021, respectively. The Illinois Department on Aging, the largest payor program for the Company’s Illinois personal care operations, accounted for 21.0% and 21.3% of the Company’s net service revenues for the three months ended September 30, 2022 and 2021, respectively, and accounted for 20.8% and 21.4% of the Company’s net service revenues for the nine months ended September 30, 2022 and 2021, respectively.

The related receivables due from the Illinois Department on Aging represented 15.3% and 16.1% of the Company’s net accounts receivable at September 30, 2022 and December 31, 2021, respectively.