Home Health Eligibility Improperly Restricted in 11 States: OIG

A report from the Office of the Inspector General of the Department of Health and Human Services finds that 11 states have improper restrictions on eligibility requirements for Medicaid home health benefits by requiring them to be homebound. 

The OIG report, sent on July 1 to Marilyn Tavenner, the administrator for the Centers for Medicare & Medicaid Services (CMS), evaluated states’ eligibility requirements for Medicaid Mandatory Home Health Services.

“In July 2011, CMS published a Notice of Proposed Rulemaking that would revise Medicaid regulations to clarify that home health services cannot be restricted to individuals who are homebound or to services furnished in the home; the rule had not yet been finalized at the time of this report,” says OIG of its decision to conduct the study. 

The OIG evaluated state plans and other policies defining eligibility criteria for benefits in all 50 states and the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands.

Of all these states and territories, the OIG found 11 violated federal regulations by restricting eligibility for home health benefits to those who were homebound: Alabama, Arkansas, Indiana, Montana, Nebraska, New Mexico, North Dakota, Pennsylvania, South Dakota, Utah, and West Virginia.

Two—New Mexico and Utah—stated in their responses to the OIG’s request that “although their policies restricted eligibility for home health services to homebound individuals, those policies were incorrect and the restrictions were not being enforced.” 

States with improper restrictions violate CMS’ interpretation of federal law because the scope of the medical assistance made available to non-homebound individuals is reduced, OIG concludes.

“We encourage CMS to finalize its proposed rule clarifying that home health services cannot be restricted to individuals who are homebound or to services furnished in the home,” says the report. 

View the report. 

Written by Alyssa Gerace

Alyssa Gerace

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