Medicare cuts to home health are a step in the wrong direction

MYour grandmother lived on top of a hill overlooking the magical mountains and valleys of the Ozarks until the day we literally had to drag her out of it. Our family was scattered across Texas and California, working full-time, so no one could check on her regularly. When she had home health workers, they helped her with her medications and her recovery from shoulder surgery. Overly friendly neighbors also helped by changing her will and emptying her bank accounts – a story for another day.

Older Americans want to be cared for in their homes as long as they can. But this is not always possible, especially when families are scattered. Home health workers make such care a reality for many families, including mine. I am part of the sandwich generation: raising 9-year-old twins and helping to care for my 87-year-old mother-in-law who lives with us. Before my father-in-law died, he dressed his wounds right in my living room. My stepmother was diagnosed with Alzheimer’s and needed support to stay in her home before finally settling into an assisted living facility five miles from my home.

Home health care offers several advantages for older Americans. It allows them to receive care in the comfort and familiarity of their own homes, close to established friends and social networks. Provides personalized care and greater independence. And it’s often more cost-effective than a nursing home. Home care also allows older Americans and people with disabilities to recover more quickly from serious injuries or illnesses with less exposure to hospital-acquired infections and rehospitalization.


Despite the popularity and benefits of home health care, access to it is threatened by deep cuts proposed by Medicare.

In its latest proposed rule, Medicare is considering implementing a nearly 8 percent permanent reduction in payments for home health services. This would mean $1.33 billion in 2023 alone, another $2 billion from early 2024 by restoring services provided to seniors and people with disabilities in the first two years of the Covid-19 pandemic, and an estimated return of $1.2 billion in services provided in 2022. Those cuts, which could reach an estimated $18 billion over the next 10 years, would be a devastating blow to the more than 3.5 million people whose home health care is covered by Medicare.


After ensuring the health and safety of older Americans during the worst public health crisis in 100 years, why is Medicare trying to cut access to home care and also take back payments for them that it made fairly and fair?

One analysis suggests that cutbacks and defunding could put 44 percent of America’s home health agencies at risk of closing, seriously jeopardizing beneficiaries’ access to care, especially in rural and underserved communities. This policy just doesn’t make sense.

The Medicare home health beneficiary population is getting older and sicker. More than 25% of home health care users nationwide are over the age of 85, and 43% have five or more chronic conditions, compared to just 22% of all Medicare patients. That means those cuts will target some of the sickest and most at-risk older Americans.

Those cuts will further limit access to home health care, which is already strained by booming demand as many Americans want to stay out of the hospital to avoid contracting the coronavirus and other infectious diseases, and exacerbated by a shortage of home health workers caused by partly because of the low pay.

Elder advocates must step up to protect access to home health care. Lawmakers in Congress introduced the Preserving Home Health Care Access Act of 2022 (HR 8581 and S. 4605). This bipartisan legislation, currently being considered by the House and Senate, would prevent Medicare from imposing these cuts until 2026, ensuring that people have continued access to care and giving providers the stability they need. while Medicare is taking longer to perfect its payment system.

A recent survey conducted by Morning Consult found that 97 percent of Medicare beneficiaries want the federal government to keep Medicare coverage for home health care, and 88 percent believe it is important for Congress to pass legislation to stop proposed cuts in payments for Medicare home health services. Almost everyone affected by this harmful policy wants something done.

Those in need of health care who are covered by Medicare deserve access to care in the setting of their choice. More than 90% of older adults say they prefer to receive continuing care or short-term care for recovery or rehabilitation in the safety of their homes. By supporting the Preserving Home Health Access Act and bringing it forward for timely passage, Congress can protect home health patients and provide stability to the home health community as demand grows.

Terry Wilcox is the co-founder and CEO of Patients Rising, a nonprofit patient education and advocacy organization that helps people access the diagnosis and treatment they need. Patients Rising is one of 13 organizations who asked Congress to pass the Preserving Home Health Access Act of 2022.

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