Two agencies that keep 600 people out of nursing homes by providing in-home care have learned the state will give them a direly needed 42 percent Medicaid rate increase. Waypoint and Ascentria Care Alliance warned the state this year that without significantly higher Medicaid payments, they’d have to end the care that allows people to manage their health needs in their homes. Doing so would leave their clients at a fork in the road: join nursing homes’ long waiting lists or try to persuade a family member to step in.