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Significant Payors | 12 Months Ended
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Dec. 31, 2023
Significant Payors [Abstract] |
Significant Payors | 13. Significant Payors For 2023, 2022 and 2021, the Company’s revenue by payor type was as follows:
|  | Personal Care |  |
|  | For the Years Ended December 31, |  |
|  | 2023 |  |  |  | 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 |  |
State, local and other governmental programs |  | $ | 400,753 |  |  |  | 50.4 |  | % |  | $ | 348,234 |  |  |  | 49.3 |  | % |  | $ | 338,325 |  |  |  | 49.3 |  | %
Managed care organizations |  |  | 367,557 |  |  |  | 46.2 |  |  |  |  | 326,778 |  |  |  | 46.3 |  |  |  |  | 311,801 |  |  |  | 45.5 |  |
Private pay |  |  | 16,268 |  |  |  | 2.0 |  |  |  |  | 18,301 |  |  |  | 2.6 |  |  |  |  | 19,991 |  |  |  | 2.9 |  |
Commercial insurance |  |  | 6,321 |  |  |  | 0.8 |  |  |  |  | 7,689 |  |  |  | 1.1 |  |  |  |  | 9,820 |  |  |  | 1.4 |  |
Other |  |  | 3,819 |  |  |  | 0.6 |  |  |  |  | 5,505 |  |  |  | 0.7 |  |  |  |  | 5,917 |  |  |  | 0.9 |  |
Total personal care segment net service revenues |  | $ | 794,718 |  |  |  | 100.0 |  | % |  | $ | 706,507 |  |  |  | 100.0 |  | % |  | $ | 685,854 |  |  |  | 100.0 |  | %
|  | Hospice |  |
|  | For the Years Ended December 31, |  |
|  | 2023 |  |  |  | 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 |  |
Medicare |  | $ | 186,317 |  |  |  | 89.9 |  | % |  | $ | 183,407 |  |  |  | 90.9 |  | % |  | $ | 142,086 |  |  |  | 93.3 |  | %
Managed care organizations |  |  | 7,037 |  |  |  | 3.4 |  |  |  |  | 7,353 |  |  |  | 3.6 |  |  |  |  | 5,664 |  |  |  | 3.7 |  |
Other |  |  | 13,801 |  |  |  | 6.7 |  |  |  |  | 11,012 |  |  |  | 5.5 |  |  |  |  | 4,503 |  |  |  | 3.0 |  |
Total hospice segment net service revenues |  | $ | 207,155 |  |  |  | 100.0 |  | % |  | $ | 201,772 |  |  |  | 100.0 |  | % |  | $ | 152,253 |  |  |  | 100.0 |  | %
|  | Home Health |  |
|  | For the Years Ended December 31, |  |
|  | 2023 |  |  |  | 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 |  |
Medicare |  | $ | 41,078 |  |  |  | 72.3 |  | % |  | $ | 31,505 |  |  |  | 73.5 |  | % |  | $ | 20,700 |  |  |  | 78.4 |  | %
Managed care organizations |  |  | 12,613 |  |  |  | 22.2 |  |  |  |  | 8,698 |  |  |  | 20.3 |  |  |  |  | 4,457 |  |  |  | 16.9 |  |
Other |  |  | 3,087 |  |  |  | 5.5 |  |  |  |  | 2,638 |  |  |  | 6.2 |  |  |  |  | 1,235 |  |  |  | 4.7 |  |
Total home health segment net service revenues |  | $ | 56,778 |  |  |  | 100.0 |  | % |  | $ | 42,841 |  |  |  | 100.0 |  | % |  | $ | 26,392 |  |  |  | 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 2023, 2022 and 2021 were as follows:
|  | Personal Care |  |
|  | For the Years Ended December 31, |  |
|  | 2023 |  |  |  | 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 |  |
Illinois |  | $ | 411,081 |  |  |  | 51.7 |  | % |  | $ | 360,778 |  |  |  | 51.1 |  | % |  | $ | 328,619 |  |  |  | 47.9 |  | %
New York |  |  | 92,469 |  |  |  | 11.6 |  |  |  |  | 86,592 |  |  |  | 12.3 |  |  |  |  | 99,732 |  |  |  | 14.5 |  |
New Mexico |  |  | 115,986 |  |  |  | 14.6 |  |  |  |  | 105,315 |  |  |  | 14.9 |  |  |  |  | 97,784 |  |  |  | 14.3 |  |
All other states |  |  | 175,182 |  |  |  | 22.1 |  |  |  |  | 153,822 |  |  |  | 21.7 |  |  |  |  | 159,719 |  |  |  | 23.3 |  |
Total personal care segment net service revenues |  | $ | 794,718 |  |  |  | 100.0 |  | % |  | $ | 706,507 |  |  |  | 100.0 |  | % |  | $ | 685,854 |  |  |  | 100.0 |  | %
|  | Hospice |  |
|  | For the Years Ended December 31, |  |
|  | 2023 |  |  |  | 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 |  |
Ohio |  | $ | 74,871 |  |  |  | 36.1 |  | % |  | $ | 70,503 |  |  |  | 35.0 |  | % |  | $ | 61,415 |  |  |  | 40.3 |  | %
New Mexico |  |  | 30,782 |  |  |  | 14.9 |  |  |  |  | 30,722 |  |  |  | 15.2 |  |  |  |  | 36,063 |  |  |  | 23.7 |  |
Illinois |  |  | 47,247 |  |  |  | 22.8 |  |  |  |  | 47,181 |  |  |  | 23.4 |  |  |  |  | — |  |  |  | — |  |
All other states |  |  | 54,255 |  |  |  | 26.2 |  |  |  |  | 53,366 |  |  |  | 26.4 |  |  |  |  | 54,775 |  |  |  | 36.0 |  |
Total hospice segment net service revenues |  | $ | 207,155 |  |  |  | 100.0 |  | % |  | $ | 201,772 |  |  |  | 100.0 |  | % |  | $ | 152,253 |  |  |  | 100.0 |  | %
With the acquisition of JourneyCare in 2022, the Company expanded its hospice services to patients in the state of Illinois.
|  | Home Health |  |
|  | For the Years Ended December 31, |  |
|  | 2023 |  |  |  | 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 |  |
New Mexico |  | $ | 32,949 |  |  |  | 58.0 |  | % |  | $ | 34,111 |  |  |  | 79.6 |  | % |  | $ | 24,735 |  |  |  | 93.7 |  | %
Illinois |  |  | 12,851 |  |  |  | 22.6 |  |  |  |  | 8,730 |  |  |  | 20.4 |  |  |  |  | 1,657 |  |  |  | 6.3 |  |
Tennessee |  |  | 10,978 |  |  |  | 19.4 |  |  |  |  | — |  |  |  | — |  |  |  |  | — |  |  |  | — |  |
Total home health segment net service revenues |  | $ | 56,778 |  |  |  | 100.0 |  | % |  | $ | 42,841 |  |  |  | 100.0 |  | % |  | $ | 26,392 |  |  |  | 100.0 |  | %
With the acquisition of Tennessee Quality Care in 2023, the Company expanded its home health services to patients in the state of Tennessee. A substantial portion of the Company’s revenue and accounts receivable is derived from services performed for state and local governmental agencies. We derive a significant amount of our net service revenues in Illinois, which represented 44.5%, 43.8% and 38.2% of our net service revenues for the years ended December 31, 2023, 2022 and 2021, respectively. The Illinois Department on Aging, the largest payor program for the Company’s Illinois personal care operations, accounted for 20.9%, 20.7% and 21.4% of the Company’s net service revenues for 2023, 2022 and 2021, respectively. The related receivables due from the Illinois Department on Aging represented 25.8% and 18.0% of the Company’s net accounts receivable at December 31, 2023 and 2022, respectively. In 2019, New York initiated a new 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. The New York fiscal year 2023 state budget, passed in April 2022, amended the 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 submitted an attestation and supporting information to the New York State Department of Health no later than November 29, 2022. The Company submitted an attestation on November 22, 2022, which allowed the Company to continue its CDPAP fiscal intermediary operations. However, the Company decided at that time to suspend materially all of its new fee-for-service patient admissions in the CDPAP through County Social Service Departments. On June 6, 2023, the New York State Department of Health notified the Company that it had received a contract award. Under this contract, the Company is providing services to all current payors and has resumed new fee-for-service patient admissions through County Social Service Departments in the CDPAP. The CDPAP continues to be targeted for changes by New York governmental authorities, however. For example, the governor’s most recent update on the state budget contained proposals that could adversely affect the Company’s ability to participate in the CDPAP. The Company recognized approximat ely $40.7 million from the program for the year ended December 31, 2023.

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