More Eligible for At-Home Care Under Medicare Settlement

More Medicare beneficiaries will be eligible for at-home care covered by the entitlement program under a proposed settlement, reports USA Today.

The settlement relates to whether beneficiaries who cannot prove their medical conditions will improve can still get coverage for skilled nursing and therapy services.

A proposed Medicare settlement that allows more patients to receive home health care services could cost the government more initially, but several experts say it could save money in the long term.


“My view is that if we build care coordination into the system, we’d save money,” said Kenneth Thorpe, chairman in the department of Health Policy and Management at Emory University.

Under the settlement, the Department of Health and Human Services agreed to change guidelines to allow skilled nursing and therapy services for people who cannot prove their medical conditions will improve. This does not include basic care, such as bathing or cooking. More than 10,000 people who were denied skilled care before the settlement will also be allowed to try again.

Thorpe said 95% of health care costs come from those with multiple chronic health issues, and monitoring those issues could substantially lower costs.


The settlement for Jimmo v. Sebelius makes it easier for people to qualify for at-home skilled nursing because it takes away the “improvement standard” that left out chronically ill or elderly patients because they hoped to maintain their conditions, rather than get better with care.

“The consumers’ lawyers said it could mean hundreds of thousands of people, while the government said it could be minimal,” said Bill Dombi, vice president of the National Association for Homecare and Hospice. “It’s been difficult for us to see what the change will look like.”

But he’s happy about the ruling, calling it an “absolute plus to the business side.” Even a 10% increase in home health patients equals about $2 million, he said.

Potentially avoidable re-hospitalizations cost Medicare billions of dollars each year, but if beneficiaries can get at-home care following a discharge from a hospital or nursing home, it could help prevent the need for emergency care. 

Read more at USA Today.

Written by Alyssa Gerace