ALBUQUERQUE — Amanda Salas, a caregiver with Heritage Healthcare Services, has been looking after people in their homes for nearly two decades.

She assists her clients — including seniors, people with disabilities and veterans — with essential activities like bathing, dressing, preparing meals and light housekeeping. Oftentimes, she helps clients stave off social isolation, too.

“We’re going into their home at their most vulnerable state. … Whether it be physically, mentally, emotionally, that’s what we’re there to provide care for,” Salas said.

Earlier this year, however, providing home-based care for New Mexico veterans became increasingly difficult.

The U.S. Department of Veterans Affairs slashed New Mexico reimbursement rates for home health aide services by 19% between 2025 and 2026. The federal agency now pays $13.50 for a quarter-hour of care, compared to a previous rate of $16.75 — a change a VA spokesperson said would make payments in the state more consistent with “prevailing market rates.”

Caregiving agencies, state officials and members of Congress say the cut will reduce access to care for a portion of the state’s 150,000 veterans. They’re calling on the VA to reverse the drop in rates.

“Veterans are a valued resource to the state of New Mexico,” said retired Brig. Gen. Jamison Herrera, Cabinet secretary of the New Mexico Department of Veterans Services. “They are the lifeblood of why we have the democracy that we do, and we need to do everything we can to assist them to get the services that they’ve incurred through their sacrifice.”

‘We need to serve them’

Comfort Keepers of Santa Fe, the local franchise of a nationwide home care company, serves between 55 and 60 clients per week, Director of Operations Judy Sanchez said, and more than two-thirds are veterans.

“They have been out there and served us, and now we need to serve them,” she said.

The agency’s caregivers provide daily living assistance for clients who would otherwise need nursing home care in parts of Santa Fe, Los Alamos, Rio Arriba and San Miguel counties and nearby pueblos.

“We can help take them to doctor’s appointments, to get their hair cut, to grocery shop … whatever they need to stay home safely and just live as independently as possible,” Sanchez said.

Doug Robertson, chair of the Home Care Association of America’s Veterans Affairs Advisory Council, said some 181,000 eligible veterans across the U.S. received federally funded personal care in their homes in fiscal year 2022.

Veterans Affairs sets the rates for care each year, with rates differing from state to state and, in some cases, city to city.

In 2025, the VA paid New Mexico “homemakers” — who provide hands-off companion care — $11.22 for every 15 minutes of work, the federal agency’s fee schedule shows. That’s $3.46 more than the national average of $7.76.

For home health aides — who perform hands-on personal care to assist with clients’ activities of daily living — the 2025 reimbursement rate was $16.75 in New Mexico, compared to a nationwide average of $11.58.

Starting Jan. 1, the reimbursement rate for home health aides dropped to $13.50 in New Mexico, according to the agency’s fee schedule. For homemakers, it dropped to $9.05.

Cuts were even deeper in Texas. In parts of the state including El Paso, Amarillo and West Texas the rate for home health aides dropped from $16.75 to $9.50 between 2025 and 2026. Homemaker reimbursements dropped from $11.22 to $6.37.

Jennifer Roy, a VA spokesperson, wrote in an email the rates changed as part of an annual review process “to ensure they align with prevailing market rates.”

“VA doesn’t anticipate this change will have any effect on the census or patient care needs at any VA facility, as the new rates reflect prevailing market rates,” Roy added.

But from providers’ perspective, Robertson said, the decreases feel “somewhat arbitrary.”

“There doesn’t seem to be consistency from one location to the next as to why a rate is what it is,” he said.

Robertson noted the reimbursement rate for a home health aide in Oklahoma remained steady at $15 per quarter-hour, while rates in the two neighboring states dropped significantly.

Veterans Affairs officials did not respond to questions from The New Mexican about the agency’s methodology for setting rates.

‘Curtailment of support’

While a few dollars’ difference might not sound like much, home care agencies rely on the federal funding to pay for a variety of costs, Robertson said.

The money is meant to cover caregivers’ salaries — which in New Mexico average around $29,000 per year, according to 2023 data from the Bureau of Labor Statistics — plus overhead like insurance, employee benefits, taxes, rent and utilities.

Robertson said the decreases were “very unusual” and isolated to New Mexico and Texas; though, many states did not see the typical increase to account for inflation. This year’s rates, he added, seem to indicate a “curtailment of support.”

“The cost of business did not decrease on Jan. 1, but the reimbursement for care in these rural communities did,” Robertson said.

He added, “Unfortunately, I do believe we’re starting to see a reduction in access to home care for veterans in New Mexico, rural Texas as a result.”

Comfort Keepers of Santa Fe isn’t planning to cut clients or reduce services as a result of the rate reductions, Sanchez said, but the company won’t be able to increase caregivers’ wages.

“Whenever we go to look at any pay increases, we won’t be able to do much, because we don’t have much left over,” she said.

That’s a problem for worker retention, she noted, because it means caregiving can’t compete with jobs in other industries.

“They’re thinking, ‘Wait a minute, I can go work at McDonald’s for the same price.’ They end up quitting,” she said.

The drop in rates comes as the home health and personal care industry faces a range of issues, including a dearth of providers and rising demand from New Mexico’s aging population.

Rural areas pose a particular challenge for the industry: While caregivers may have to drive hours to see clients in far-flung parts of the state, the agencies they work for don’t get reimbursed for drive time, increasing the cost of care.

Meggin Lorino, executive director of the New Mexico Association for Home and Hospice Care, said cuts to Veterans Affairs reimbursement rates are “part of a bigger trend that we are seeing.”

“Our agencies are already operating on razor-thin margins,” Lorino said. “There are reports that over half of the home health agencies in New Mexico have negative margins for the home health side of the business.”

Urging VA to reconsider

New Mexico’s congressional delegation, as well as the Home Care Association of America and state officials, have called on the VA to reconsider the rate cuts in New Mexico.

A letter sent this week to Veterans Affairs Secretary Douglas Collins and signed by all five members of New Mexico’s congressional delegates — plus a Congress member from Texas — called the cuts “unacceptable and irresponsible.”

“Our country’s veterans answered the call to serve and defended our freedoms,” the letter said. “They should have access to the care they have earned and need to live in dignity. Your cuts directly threaten that.”

In addition to asking for more information about the VA’s methodology in establishing reimbursement rates and questioning why the VA rate changes specifically targeted New Mexico and Texas, the congressional delegation’s letter asserted the rate decreases will limit veterans’ access to care.

“These providers ensure that veterans are cared for and not forgotten,” the letter said. “Without them, many veterans would have nowhere to turn.”

Herrera, from the state Department of Veterans Services, joined counterparts from other states this week in Washington, D.C., to meet with federal officials and encourage them to reverse the cuts.

“We already have limits on what’s available in rural New Mexico for some of these specialized services and some of the care providers. … And the needs of these veterans aren’t going down as they’re getting older; they’re going up,” he said.

Working with members of Congress, Home Care Association of America is also asking the VA to reverse course on the cuts in New Mexico and Texas.

Robertson remains hopeful the agency will reconsider.

“We would just implore the VA to also continue to have some nominal increase each year — as they have had for the last couple of years, to keep up with those increased costs — and certainly not a 19% or 43% reduction,” Robertson said. “That really can impact access to care.”