The Key Problems with Medicare’s Home Health Benefit

Home-based care services are a crucial element of medical care.

Despite this fact, issues surrounding accessibility have hindered the Medicare home health benefit’s ability to be effective, a new report published in Health Affairs Thursday suggests.

The report was authored by Henry J. Kaiser’s President Barbara Lyons, as well as Diane Rowland, the former executive vice president of and emerita of the foundation.


For Medicare beneficiaries, access to home health services isn’t always a given. This is the case for a number of reasons, according to the report.

Sometimes, individuals who need and qualify for these services aren’t aware of them. Physicians not ordering home health services is another factor, as well as providers not always delivering required care.

Among home health providers, there is often confusion about what is covered and financial incentives due to Medicare’s payment systems, quality measures and audit systems, according to the report.


Plus, there are challenges around hospitals making referrals to home health providers.

“Even a referral upon hospital discharge for Medicare home health benefits is not sufficient, with disparities by race, ethnicity and residence ZIP code,” the authors wrote in the report.

The authors suggest that the federal government should beef up the quality and transparency of public program data by race, ethnicity, language, age, disability status and residence for home health referrals.

“Such efforts are necessary to examine and eliminate disparities in access to home health services and to hold providers accountable,” the authors wrote. “To better understand how racism and culture affect access and use of home health services, federal officials should invest in research and community partnerships to engage and work with diverse communities of Medicare beneficiaries, their caregivers and the providers anchored in these communities.”

When it comes to upholding home-based care services, Medicaid can be a good model to follow for Medicare, according to the authors.

“Over the past two decades, Medicaid has prioritized access to home and community-based service,s including personal care services,” they wrote. “Key strategies that support equitable access to in-home services include centering the beneficiary in decision making, systematic referral and provision of services, eliminating conflicts in payment incentives, and a fairly compensated direct care workforce.”

The U.S. Centers for Medicare and Medicaid Services’ (CMS) effort to integrate care for dual-eligible beneficiaries will make room for the Medicare home health benefit to serve as a supplement to Medicaid’s service package, according to the report.

The report highlights the need to clarify Medicare’s home health benefits policy.

“Policymakers must ensure that federal policy and regulatory practices align with current law, driving provider actions to offer the full range of services, not just skilled care,” the authors wrote.

Understanding Medicare policy will become increasingly important with the upcoming nationwide expansion Home Health Value-Based Purchasing (HHVBP) Model.

Finally, the report also urges Congress to investigate the roadblocks that beneficiaries face when trying to utilize the Medicare home health benefit.