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As we have reported, the Center for Medicare Advocacy has been hearing from people unable to access Medicare-covered home health care, or the appropriate amount of care, despite meeting Medicare coverage criteria.  In particular, people living with long-term and debilitating conditions find themselves facing significant access problems.

In a January 17 NPR article, Susan Jaffe of Kaiser Health News covered this home health access problem and featured two beneficiaries who need this care. One of these individual, Colin Campbell, lives with ALS and has been told by 14 Home Health providers that Medicare won’t cover his home care – an all too common, but incorrect, statement.  Center for Medicare Advocacy Associate Director Kathleen Holt explained: "Medicare coverage laws are not being enforced and people are not getting the care that they need in order to stay in their homes."

Federal law authorizes Medicare to pay indefinitely for home care – with no copayments or deductibles – if a doctor ordered it, the patient can leave home only with great difficulty, and the patient meets skilled care requirements. In particular, to obtain Medicare home health coverage, patients must need part-time or intermittent nursing or therapy to maintain, improve or slow decline of their condition. They do not need to show improvement to qualify for coverage.

M. Shepard, January 17, 2018

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