Senate Bill Aims to Increase Home Health Access, Limit Nursing Homes

A bipartisan bill introduced by two U.S. Senators would create a new project that would increase home care access for more older Americans, in turn keeping them out of costlier and more institutionalized care settings like nursing homes.

The proposed legislation, introduced last week by Sen. Chuck Grassley (R-IA) and Sen. Ben Cardin (D-MD), is born from concerns regarding the federal government’s payment for long-term services and supports via Medicaid.

Grassley and Cardin stress that under the current system what frequently happens is that seniors on Medicare go into a nursing home, spend down their assets and then become eligible for Medicaid for their long-term care.


“Everybody wants to stay in their own home as long as they can, with the comforts of home,” Grassley said in a written statement. “Unfortunately, our current system doesn’t have a bridge for those who are on a fixed income but would have to sell their house to become eligible for Medicaid and get nursing home care.”

The bill, Grassley says, sets up a demonstration project that would build a bridge for those who need care but otherwise would have to go to a nursing home to get it.

Specifically, the Grassley-Cardin bill would establish a new Community-Based Institutional Special Needs Plan (CBI-SNP) demo program, which would target home- and community-based services for low-income, Medicare-only beneficiaries who need help with two or more activities of daily living — usual criteria for nursing home eligibility.


At first, the demonstration would operate in up to five states, building on Medicare Advantage plans that have experience caring for this frail population.

The plans would tailor services to beneficiaries, depending on individual needs. For example, plans might provide assistance with bathing or dressing, housekeeping or transportation, or even respite care for their primary caregiver. 

Grassley and Cardin, both members of the Senate Finance Health Care Subcommittee, intend the demo project would generate evidence to support an alternative payment methodology that could produce savings for both states and the federal government.

One estimate shows four-year savings of nearly $60 million for a demonstration of 5,000 Medicare members by postponing or preventing hospitalization and institutionalization.

“Allowing seniors to age in place, to stay in their homes as long as possible, takes an enormous financial and emotional burden off of families,” said Sen. Cardin. “This community based approach gives seniors the support and dignity they deserve and is a commonsense alternative to costly institutionalization.”

The bill will be assigned to the Finance Committee, with jurisdiction over Medicare and Medicaid.  

Written by Jason Oliva