Home Care Advocates Ready to Fight Co-Pay Proposals—Again

While industry advocates have battled proposals for home health co-pays in the past, for some it has been a frustrating fight without end.

Co-pays are an issue that will not go away, according to James Fuccione, director of Legislative & Public Affairs for Home Care Alliance of Massachusetts.

“We’re frustrated any time a co-pay proposal comes out, but this time we’re very disappointed it’s still an issue at this point,” says Fuccione. “It places an extra burden on seniors who have to pay enough already.”


The Obama Administration’s FY 2014 budget proposes a co-payment of $100 per home health episode for new Medicare beneficiaries, applying to episodes with five or more visits not preceded by a hospital or other inpatient post-acute stay.

While the proposal would not kick in for new Medicare enrollees until 2017 if implemented, home health professionals are already wary the law would drive patients to costlier care settings.

For seniors living on limited or fixed incomes, co-pays for home health services could cause them to forego care, says Kyle Simon, government affairs director of the Home Care Association of Florida.


“In extreme cases, beneficiaries with chronic conditions could opt to move into more expensive institutions like nursing homes, further stressing state Medicaid budgets,” says Simon.

Seniors who faced increasing co-pays ended up having fewer outpatient visits, but more and longer hospitalizations, according to a study from the New England Journal of Medicine.

In the year after a rise in co-payments, plans that increased cost sharing had 19.8 fewer annual outpatient visits per 100 enrollees, 2.2 additional annual hospital admissions and 13.4 more annual inpatient days. Additionally, increased co-pays led to an increase of 0.7 percentage points in the proportion of enrollees that were hospitalized.

When it comes to an individual’s health and the option of foregoing care services, seniors will have no choice but to put up the $100 per episode, says Lenny Verkhoglaz, CEO of Executive Home Care.

“Nobody likes co-pays, that’s for sure,” says Verkhoglaz. “I think [co-pays] will create a lot of unhappy clients.”

Written by Jason Oliva