Significant Payors

12 Months Ended

Dec. 31, 2024

15. Significant Payors

For 2024, 2023 and 2022, the Company’s revenue by payor type was as follows:


	Personal Care
	For the Years Ended December 31,
	2024					2023					2022
	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	$	456,885		53.3	%	$	400,753		50.4	%	$	348,234		49.3	%
Managed care organizations		376,604		44.0			367,557		46.2			326,778		46.3
Private pay		15,589		1.8			16,268		2.0			18,301		2.6
Commercial insurance		5,593		0.7			6,321		0.8			7,689		1.1
Other		1,910		0.2			3,819		0.6			5,505		0.7
Total personal care segment net service revenues	$	856,581		100.0	%	$	794,718		100.0	%	$	706,507		100.0	%


	Hospice
	For the Years Ended December 31,
	2024					2023					2022
	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	$	208,099		91.2	%	$	186,317		89.9	%	$	183,407		90.9	%
Managed care organizations		7,603		3.3			7,037		3.4			7,353		3.6
Other		12,489		5.5			13,801		6.7			11,012		5.5
Total hospice segment net service revenues	$	228,191		100.0	%	$	207,155		100.0	%	$	201,772		100.0	%


	Home Health
	For the Years Ended December 31,
	2024					2023					2022
	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	$	48,562		69.5	%	$	41,078		72.3	%	$	31,505		73.5	%
Managed care organizations		17,603		25.2			12,613		22.2			8,698		20.3
Other		3,662		5.3			3,087		5.5			2,638		6.2
Total home health segment net service revenues	$	69,827		100.0	%	$	56,778		100.0	%	$	42,841		100.0	%

The Company has derived 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 2024, 2023 and 2022 were as follows:


	Personal Care
	For the Years Ended December 31,
	2024					2023					2022
	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	$	441,012		51.5	%	$	411,081		51.7	%	$	360,778		51.1	%
New York (1)		71,763		8.4			92,469		11.6			86,592		12.3
New Mexico		115,381		13.5			115,986		14.6			105,315		14.9
All other states		228,425		26.6			175,182		22.1			153,822		21.7
Total personal care segment net service revenues	$	856,581		100.0	%	$	794,718		100.0	%	$	706,507		100.0	%

(1)

The selection process for the New York Consumer Directed Personal Assistance Program (“CDPAP”) fiscal intermediaries has changed significantly in recent years and the program continues to be an area of focus for New York governmental authorities. As a result of the changes and uncertainty in the state, the Company determined that its New York personal care operations no longer fit its growth strategy and is divesting these operations. See Note 5 to the Notes to Consolidated Financial Statements, Divestiture, for additional details regarding our divestiture.


	Hospice
	For the Years Ended December 31,
	2024					2023					2022
	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	$	84,811		37.2	%	$	74,871		36.1	%	$	70,503		35.0	%
New Mexico		28,532		12.5			30,782		14.9			30,722		15.2
Illinois		52,560		23.0			47,247		22.8			47,181		23.4
All other states		62,288		27.3			54,255		26.2			53,366		26.4
Total hospice segment net service revenues	$	228,191		100.0	%	$	207,155		100.0	%	$	201,772		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,
	2024					2023					2022
	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	$	32,766		46.9	%	$	32,949		58.0	%	$	34,111		79.6	%
Illinois		10,564		15.1			12,851		22.6			8,730		20.4
Tennessee		26,497		38.0			10,978		19.4			—		—
Total home health segment net service revenues	$	69,827		100.0	%	$	56,778		100.0	%	$	42,841		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 43.7%, 44.5% and 43.8% of our net service revenues for the years ended December 31, 2024, 2023 and 2022, respectively. The Illinois Department on Aging, the largest payor program for the Company’s Illinois personal care operations, accounted for 21.0%, 20.9% and 20.7% of the Company’s net service revenues for 2024, 2023 and 2022, respectively.

The related receivables due from the Illinois Department on Aging represented 21.7% and 25.8% of the Company’s net accounts receivable at December 31, 2024 and 2023, 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 which the Company provided services during 2023 and 2024. 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. See Note 5 to the Notes to Consolidated Financial Statements, Divestiture, for additional details regarding our divestiture of our operations in New York, including CDPAP operations.