Year-End Checklist for Medicaid-Based Agencies: What to Wrap Up Before January

Close the year strong, reduce risk, and set your team up for success in 2026.

As the calendar winds down, most people are preparing for the holidays. But if you run or support a Medicaid-funded home or community-based care agency, year-end is one of the busiest—and most critical—times of the year.

From billing and compliance to staffing and policy prep, what you do in Q4 can have a direct impact on your financial health and operational stability in Q1.

Here’s a practical, agency-focused checklist to help you wrap up 2025 right and head into 2026 with confidence.

1. Close Out Outstanding Billing Cycles

Don’t leave money sitting on the table over the holidays.

• Review all pending claims and ensure visit documentation and EVV are complete.

• Resolve rejections or denials—especially for MCOs with tighter year-end submission cutoffs.

• Double-check that authorizations align with billed units and that services weren’t delivered past expiration dates.

• Confirm submission deadlines for Medicaid and third-party payers. Some may close early or delay payments in January.

Tip: Use your billing dashboard to flag anything older than 30 days and create a “clean claims” queue.

2. Audit Documentation and Compliance Records

Make it a goal to be audit-ready before January hits.

• Ensure care plans are up to date and signed (especially for clients with renewals in Q1).

• Check for missing visit notes or late documentation and follow up with field staff.

• Validate EVV submissions against scheduled visits for accuracy.

• Review staff credentials and trainings to ensure no certifications have lapsed or expired.

Bonus: Run a mock audit to simulate a request from your state or an MCO—it’ll surface gaps before they become problems.

3. Prep for Policy and Rate Changes in 2026

Policy shifts tend to roll out quietly over the holidays.

• Review state and MCO bulletins for any announced rate changes, documentation updates, or service code adjustments.

• Update your scheduling, billing, and authorization rules in your system to reflect changes before they go live.

• Train key staff on what’s changing and how it impacts daily operations (especially billing and intake).

4. Forecast Staffing and Scheduling Needs

The new year often comes with changes in client volume, budgets, and coverage needs.

• Assess open positions and caregiver availability to ensure January coverage.

• Balance PTO requests with client needs and team capacity.

• Use historical data to forecast seasonal trends and avoid last-minute scheduling chaos.

5. Evaluate Your Tools and Tech

If your systems made 2025 harder than it needed to be, now’s the time to plan for better.

• Ask your team what tools worked—and what didn’t.

• Evaluate system gaps in billing, documentation, scheduling, and EVV.

• Consider switching to or optimizing a more scalable, Medicaid-friendly platform.

6. Celebrate the Wins (and Your Team)

Don't forget the human side of year-end.

• Recognize staff achievements, retention milestones, and clinical wins.

• Host a quick team wrap-up session to share reflections and 2026 goals.

• Invite staff feedback on how the agency can improve next year—especially from those in the field.

Finish Strong, Start Smarter

Running a Medicaid agency comes with high stakes and constant change—but year-end doesn’t have to be overwhelming. With the right checklist and the right tools, you can wrap up the year with clarity and start 2026 on solid ground.

At Statewise, we help agencies streamline Medicaid operations so nothing gets missed—whether it’s a claim, a credential, or an opportunity to grow.