Medicare Can Cover a Lot More Home Care: Witness to Senate Panel

The Reality

“Unfortunately, Stein said, “the center hears regularly from people who meet Medicare coverage criteria but are unable to access Medicare-covered home care or the appropriate amount of care.”

Getting access to home health aides to provide help with activities such as bathing can be especially challenging, even though federal law authorizes Medicare coverage of 28 to 35 hours a week of home health aide services.

Stein said Medicare creates disincentives for long-term home care benefits use by:

Paying more for the first 30 days of services than for services after 30 days.
Paying more for home health services for patients who come from a hospital or institution.
Using a quality measurement system that rewards only improvement in conditions, not success at efforts to maintain people’s health or slow deterioration.

“We need auditing that looks at underutilization, not just so-called ‘over-utilization,’” Stein added.

The Home Care Supply

David Grabowski, a Harvard Medical School professor, testified that he believes that Medicare provides generous payments for home health care in most of the country, and that the program should aim any extra payments meant to increase the supply of home care services at rural areas, where services may be more difficult to find.

Other witnesses noticed that Medicare may give an inaccurate picture of patients’ access to home care services by showing that the patients have adequate access if they live in the service area of at least two home care agencies, even if the agencies are overloaded and are not accepting new patients.

William Dombi, president of the National Association of Home Care & Hospice, said in testimony at the hearing and in written testimony that trends in the amount of home care covered by Medicare show that the home health services benefit is in trouble.

In 2021, Medicare paid for an average of 25.4 visits for just 3 million enrollees, down from an average of 74 visits for 3.6 million enrollees in 1997, Dombi said.

Medicare spending on home health services increased to just $16.9 billion in 2021, from $16.7 billion in 1997, as Medicare spending on skilled nursing facilities increased to $27.2 billion, from $11.2 billion.

“The evidence is mounting that patients in need of home health services are dealing with major barriers to access to care today, some of which may reach a point where they are insurmountable,” Dombi said.

Judith Stein. Credit: Senate Finance