Electronic Visit Verification is mandatory for Medicaid-funded home care under the 21st Century Cures Act — personal care since 2020, home health since 2023. Every credible platform is compliant; what differs is the aggregator relationship. HHAeXchange leads as the aggregator of record in several states; AlayaCare leads for EVV inside an integrated platform; AxisCare leads for optional non-Medicaid EVV.
Under the 21st Century Cures Act, EVV is required for all Medicaid-funded personal care services (since January 2020) and home health services (since January 2023). Those mandates are fully in force in 2026. EVV must capture six data points: the type of service, the individual receiving it, the date, the location, the individual providing it, and the time it begins and ends.
The practical question isn’t whether a platform is compliant — they all are — but whether it functions as your state’s aggregator or submits to one. HHAeXchange serves as the aggregator in several states; AlayaCare and AxisCare are compliant and submit to the state aggregator.
Functions as the state EVV aggregator in New York, New Jersey, Illinois, and others — the deepest EVV integration available.
Compliant EVV inside a modern multi-service cloud platform — strong when EVV is one requirement among many.
Cures Act–compliant EVV for non-medical agencies that want caregiver accountability without Medicaid complexity.
HHAeXchange is the EVV vendor of record for many state Medicaid programs. Where it serves as the aggregator, your EVV data flows through it to the state — there’s no deeper EVV integration available. For Medicaid-heavy agencies in those states, the EVV decision is effectively made for you, and HHAeXchange is the answer.
Medicaid-heavy agencies, multi-state Medicaid, EVV-driven
AlayaCare delivers compliant EVV inside a modern platform that also handles scheduling, billing, and multi-service workflows. It submits to state aggregators rather than serving as one, so in HHAeXchange-mandated states it often complements rather than replaces. For agencies where EVV is one of many requirements, the integrated approach is appealing.
Tech-forward mid-market to enterprise, multi-service agencies
AxisCare’s EVV is Cures Act–compliant and integrates with state aggregators where required. Its sweet spot is non-medical agencies that want EVV for accountability and proof of service — including on private-pay visits, where EVV is optional but valuable. Simple, compliant, and not overbuilt.
Non-medical agencies, 10–250 caregivers, mid-market growth
| HHAeXchange | AlayaCare | AxisCare | |
|---|---|---|---|
| Founded | 2008 | 2014 | 2011 |
| HQ | New York, NY | Montreal, QC | Waco, TX |
| Focus | Medicaid home care, HHA workflow, EVV compliance | Home care + home health + community care; cloud-native | Non-medical home care (personal care, companion care) |
| Best for | Medicaid-heavy agencies, multi-state Medicaid, EVV-driven | Tech-forward mid-market to enterprise, multi-service agencies | Non-medical agencies, 10–250 caregivers, mid-market growth |
| Install base | ~700,000 caregivers across 6,000+ agencies | ~800+ agencies | ~5,000+ agencies |
| Pricing model | Per-billable-hour + monthly fee | Per module + per user | Per active caregiver |
| Mid-market spend | Varies widely by state Medicaid contract | ~$1,000–3,000/mo | ~$300–600/mo (50 caregivers) |
| EVV compliant | Yes | Yes | Yes |
| Caregiver app | iOS + Android | iOS + Android | iOS + Android |
| Analytics | Medicaid + EVV-focused | Advanced (Visit Optimizer AI) | Standard reporting |
| Integration ecosystem | State Medicaid + payer integrations | API + iCarol (acquired call center) | API + select partners |
| Implementation | 8–16 weeks | 6–16 weeks | 2–6 weeks |
| HeyHomeCare integration | Not connected · forwarding works | Built · on once the partner agreement is signed | Connected through the API |
EVV compliance isn’t only about having the right platform — it’s about catching the missed clock-in in time. In many states, a clock-in that lands after the penalty window can mean a denied Medicaid reimbursement. The platform records the miss; it doesn’t chase it down.
HeyHomeCare does. It watches clock-in state from your scheduling system (AxisCare today), notices when a clock-in is overdue and reaches the caregiver first — by default a text with a clock-in link at 10 minutes and an automated call at 15 — before it checks with the client. If the caregiver can’t make it, it starts a call-off under your business rules. It never clocks anyone in or out and does not submit EVV records; submission stays with HHAeXchange or your platform of record. An agency that runs on HeyHomeCare itself clocks in there — GPS in the caregiver app, by phone or by a texted link, with visits outside its rules in a Needs review queue — but HeyHomeCare doesn’t submit visits to state aggregators, so that suits private pay, not a Medicaid book.
These assessments come from each vendor’s API documentation (HeyHomeCare connects to AxisCare today and has built against AlayaCare’s published API), the vendors’ public documentation, aggregate ratings on Capterra and G2, and what agency operations leads told us on discovery calls. No vendor paid for placement. For the regulation itself, go to the primary sources: the CMS EVV guidance and your state Medicaid agency’s EVV page — see also our EVV requirements by state reference.
Verify vendor claims against the primary sources:
Vendor facts last reviewed August 2026; aggregator designations shift as states re-procure, so we re-check this guide quarterly.
HeyHomeCare notices a missed clock-in and reaches the caregiver first — a text with a clock-in link, then an automated call — and if they can’t make it, starts a call-off under your business rules. It never clocks anyone in and never submits EVV records; that stays with your platform.