A small home care agency — say 5 to 50 caregivers — shouldn’t start on an enterprise platform. The cost and complexity are mismatched. For most small private-pay agencies the answer is AxisCare; for small Medicaid agencies, HHAeXchange; and for tech-forward small agencies planning to scale, AlayaCare (with a cost caveat). Here’s how to choose.
We mean roughly 5 to 50 caregivers — often a first software purchase, frequently owner-operated, and almost always budget-sensitive. At this size, the wrong call isn’t picking the “weaker” platform; it’s picking an enterprise platform whose cost and configuration overhead you’ll fight for years.
The right small-agency platform does three things: covers compliance and EVV out of the box, stays affordable at low caregiver counts, and scales cleanly as you grow — so you’re not forced into a painful migration the moment you cross 50.
Purpose-built, affordable at low caregiver counts, and live in 2–6 weeks. The most common first-software purchase for small non-medical agencies.
Even small Medicaid agencies need the aggregator-grade EVV and billing HHAeXchange provides — especially in HHAeXchange-mandated states.
Worth it if you’re building to scale and want modern cloud + Visit Optimizer early — but it costs more and takes longer to implement.
AxisCare is the small-agency default. Its starter pricing and per-active-caregiver model keep costs sane at low headcount, it implements in 2–6 weeks, and it covers the non-medical workflow without enterprise complexity. Crucially, it scales with you — an agency that starts on AxisCare at 15 caregivers rarely needs to switch at 150.
Non-medical agencies, 10–250 caregivers, mid-market growth
Small doesn’t exempt you from Medicaid rules. A small Medicaid agency still needs aggregator-grade EVV and billing, and in HHAeXchange-mandated states HHAeXchange is the practical requirement. It’s more complex than AxisCare, but for a Medicaid book the compliance depth isn’t optional.
Medicaid-heavy agencies, multi-state Medicaid, EVV-driven
AlayaCare is the “build for scale” pick — modern cloud, strong analytics, and Visit Optimizer from day one. The caveat is real: it costs more (typically $1,000–3,000/month) and takes longer to implement than AxisCare, which is a lot to carry at 20 caregivers. Choose it only if you’re genuinely building toward multi-service scale soon.
Tech-forward mid-market to enterprise, multi-service agencies
| AxisCare | HHAeXchange | AlayaCare | |
|---|---|---|---|
| Founded | 2011 | 2008 | 2014 |
| HQ | Waco, TX | New York, NY | Montreal, QC |
| Focus | Non-medical home care (personal care, companion care) | Medicaid home care, HHA workflow, EVV compliance | Home care + home health + community care; cloud-native |
| Best for | Non-medical agencies, 10–250 caregivers, mid-market growth | Medicaid-heavy agencies, multi-state Medicaid, EVV-driven | Tech-forward mid-market to enterprise, multi-service agencies |
| Install base | ~5,000+ agencies | ~700,000 caregivers across 6,000+ agencies | ~800+ agencies |
| Pricing model | Per active caregiver | Per-billable-hour + monthly fee | Per module + per user |
| Mid-market spend | ~$300–600/mo (50 caregivers) | Varies widely by state Medicaid contract | ~$1,000–3,000/mo |
| EVV compliant | Yes | Yes | Yes |
| Caregiver app | iOS + Android | iOS + Android | iOS + Android |
| Analytics | Standard reporting | Medicaid + EVV-focused | Advanced (Visit Optimizer AI) |
| Integration ecosystem | API + select partners | State Medicaid + payer integrations | API + iCarol (acquired call center) |
| Implementation | 2–6 weeks | 8–16 weeks | 6–16 weeks |
| HeyHomeCare integration | Connected through the API | Not connected · forwarding works | Built · on once the partner agreement is signed |
For a 20-caregiver agency, budget roughly $200–500/month for the agency-management platform itself. That’s the real number to plan around — and it’s why enterprise platforms (often $1,000–4,000/month) are a poor fit until you’re much larger.
The bigger small-agency cost is usually people, not software. The after-hours phone is the obvious example: hiring a dedicated coordinator to cover nights and weekends runs $30–60K/year. HeyHomeCare’s AI can answer those calls and texts and work your business rules, with your on-call manager behind it for anything that needs a person. And a private-pay agency can skip the separate platform and run on HeyHomeCare. Self-serve CRM from $500/month for up to 50 active caregivers. Larger agencies, after-hours-only service and scheduling integrations: talk to sales.
HeyHomeCare answers your caregivers' calls and texts after hours and works your business rules, with your on-call manager behind it: beside your platform, or as your whole system if you run a private-pay agency on HeyHomeCare. Self-serve CRM from $500/month for up to 50 active caregivers. Larger agencies, after-hours-only service and scheduling integrations: talk to sales.