As we move through the first quarter of 2026, the usage of Electronic Visit Verification (EVV) has shifted from a phase of “getting started” to a period of “strict enforcement.” For home care agency owners, the focus is no longer just on having a system in place; it is on maintaining a high compliance score to avoid immediate payment sanctions.
The federal mandate under the 21st Century Cures Act is now fully operational across the United States for both Personal Care Services (PCS) and Home Health Care Services (HHCS). However, because each state manages its own implementation model and aggregator, the rules of engagement vary significantly depending on where you operate.
1. Understanding the 2026 Enforcement Thresholds
In 2026, states are moving away from “soft edits” where claims are paid despite minor data errors to “hard edits” that trigger automatic denials. For example, Minnesota recently announced that beginning in early 2026, providers must meet at least a 50% compliance rate for all visits, with that threshold jumping to 80% by July 1, 2026.
This shift means your electronic visit verification (EVV) System must do more than just record time; it must act as a real-time auditor. If your caregivers are not capturing the six required data points service type, individual served, date, location, caregiver identity, and exact times your revenue cycle is at immediate risk.
2. State-by-State Breakdown: Models and Models and Updates
While the federal government sets the baseline, the “aggregator model” chosen by each state determines how you submit your data. Here is how key markets are operating in 2026:
The “Open” or “Hybrid” States: Colorado and Arizona
States like Colorado and Arizona continue to favor flexibility. Providers can use the state-sponsored system (typically Sandata) for free or choose their own third-party vendor. If you opt for a third-party solution, your data must seamlessly integrate with the state’s aggregator. Using a specialized myEZhome care software is often the preferred choice here, as it allows agencies to keep their clinical, scheduling, and EVV data in one unified platform rather than juggling multiple portals.
The “State-Mandated” States: Connecticut and Ohio
In these “Closed” models, the state requires all providers to use a specific external vendor. While this standardizes data, it can create “data silos” if your office staff has to manually move information from the state’s EVV portal into your agency’s private records.
New 2026 Enforcement: Texas and Minnesota
Texas has resumed strict EVV usage reviews as of March 2026. Agencies falling below an 80% usage score meaning they rely too heavily on manual edits rather than mobile app clock-ins will now face formal corrective action plans. Similarly, Minnesota’s DHS is now conducting quarterly reviews to ensure providers are meeting the new 2026 compliance benchmarks.
3. The Danger of Manual Edits in the “Audit Era”
A major trend for 2026 is the crackdown on “Manual Visit Entries.” State auditors view manual edits as a primary indicator of potential fraud or administrative negligence. In states like Pennsylvania, exceeding a 15% manual edit threshold will now trigger an automatic letter of non-compliance.
To protect your agency, your clinical documentation must be airtight. When your EVV is fully integrated into your Electronic Health Record (EHR) software, the system can automatically flag “missing clock-outs” or “location mismatches” before the visit is finalized. This allows your office team to address errors while the caregiver is still in the field, keeping your manual edit rate well below the audit trigger levels.
4. Securing Your Agency with myEZcare
In 2026, compliance isn’t just about checking a box; it’s about building a culture of data integrity. As states move toward real-time reporting and AI-driven fraud detection, your agency needs a partner that understands the nuances of state-specific billing and security.
Utilizing a HIPAA Compliant Software ensures that your patient data is protected while you navigate the complexities of state aggregators. By centralizing your operations with myEZcare, you can manage multiple state requirements from a single dashboard, ensuring that your agency remains compliant, profitable, and focused on what matters most: patient care.
Frequently Asked Questions (FAQ)
What is the most common reason for EVV claim denials in 2026?
The most common reason is a “Record Not Found” error. This happens when the data in your EVV system does not perfectly match the data on your billing claim (such as mismatched service codes or dates), causing the state aggregator to reject the match.
Can I still use paper timesheets in 2026?
While some states allow paper timesheets for specific “limited technology” exemptions, they must almost always be accompanied by a manual entry into a digital system. In 2026, relying on paper is considered a high-risk practice that will likely trigger a state audit.
How does “GPS Verification” work for 2026 EVV compliance?
The system captures a “ping” of the caregiver’s location only at the start and end of the visit. It does not track their movement throughout the day. This data is then compared against the patient’s authorized service address to verify the visit occurred at the correct location.
What is an “EVV Aggregator”?
An aggregator is a centralized system (like Sandata or HHAeXchange) used by the state to collect and verify data from all the different EVV vendors used by providers. It acts as the “middleman” between your agency and the state’s Medicaid payment system.
Do live-in caregivers have to use EVV in 2026?
Rules for live-in caregivers vary by state. Many states allow live-in staff to submit a single daily record rather than clocking in and out for every individual task, but you must usually have a formal “Exemption Attestation” on file with the state to use this method.
What happens if my agency falls below the state compliance threshold?
If your compliance score falls below the mandated level (e.g., 80% in Texas or 50% in Minnesota), you will typically receive a notice of non-compliance and be required to submit a Corrective Action Plan (CAP). Continued failure can lead to payment suspensions or termination from the Medicaid network.
