Medicaid coverage for hospital-at-home sought by providers

As the Centers for Medicare and Medicare Services weighs the future for hospital-at-home services under Medicare, providers are pressing more states to extend it to Medicaid beneficiaries.

Eight states—Arizona, Arkansas, Massachusetts, Michigan, Oregon, Oklahoma, South Dakota and Texas—either have policies or have passed legislation allowing Medicaid beneficiaries to receive hospital-level care in their homes, and New York is considering such a move.

Hospital-at-home providers including Medically Home; Peoria, Illinois-based OSF Healthcare; Portland, Oregon-based Oregon Health and Science University Hospital; and advocacy group Moving Healthcare Home are calling for more states to cover acute care at home.

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At the National Conference of State Legislatures’ annual legislative summit in Indianapolis this week, Lisa Tripp, government affairs vice president for hospital-at-home technology company Medically Home, demonstrated how patients receive hospital-level care inside a makeshift home on the floor of the Indiana Convention Center.

Tripp hoped that showing lawmakers how patients interact with physicians virtually and receive 24/7 remote patient monitoring would convince them to add the care model to their state Medicaid programs.

“When you say the words hospital-at-home, they don’t really understand it.” Tripp said. “They know what a hospital is and they know what a home is. So, we show them and they experience it.”

OSF Healthcare  has been working with Illinois state legislators to get its hospital-at-home program in Peoria covered under Medicaid, said Chris Manson, its vice president of government relations.

Hospital-at-home lets patients receive acute-level care in their homes through in-person and virtual visits that are supplemented by remote patient monitoring. The model took off during the COVID-19 pandemic in 2020 when the Centers for Medicare and Medicaid Services launched the Acute Care at Home waiver program. The waiver–set to expire at the end of 2024–allows hospitals to get paid the same rate for in-facility and home-based care. More than 280 hospitals across 37 states are taking part in the Medicare waiver program.

The future success of the care model hinges on scaling it further, said Shannon Germain Farraher, a healthcare analyst at research company Forrester. Farraher called the small number of state Medicaid programs covering hospital-at-home “unfortunate,” and added that denying low-income patients access to in-home care could create health disparities.

Approximately 68 million Americans are covered under the Medicaid and Children’s Health Insurance Program, compared with 60 million Americans covered under Medicare, according to the nonprofit KFF.

The care model, which has been associated with lower hospital than facility-based care costs, could result in significant cost savings for Medicaid. Medicaid programs spent $245.3 billion, or 37% of total Medicaid funding, on hospital care in 2021, according to the Medicaid and CHIP Payment and Access Commission.

Hospital-at-home could also help states better identify the needs of at-risk Medicaid beneficiaries, according to Medically Home’s Tripp. Access inside patients’ homes could help providers evaluate whether they need other health or social services.

States may be holding off on coverage of hospital-at-home until CMS completes its analysis of the program under Medicare and determines what rates it will pay for in-home acute care, said Mark Pauly, healthcare management professor at the University of Pennsylvania’s Wharton School. He said he thinks CMS could provide a roadmap that more states could choose to follow as well.


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