Pilot could bring home care coverage to Medicare

Medicare enrollment form and pen
A reimbursement program could delay or eliminate nursing facility or hospital admissions for elderly patients, possibly saving $60 million a year according to two legislators. (Image: Getty/zimmytws)

Legislators are pushing for a pilot program with Medicare Advantage enrollees that could pave the way for reimbursement of home-based care options under Medicare.

The bipartisan plan, backed by Sen. Chuck Grassley, R-Iowa, and Sen. Ben Cardin, D-Md., would be applied in five states to build on similar offerings in Medicare Advantage plans, according to a post announcing the bill's reintroduction. The program would be tailored to the needs of specific enrollees, like covering assistance with housekeeping or transportation for patients, or offering relief for caregivers. Similar moves have gained steam among private payers as well.

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The senators argue that offering reimbursement for home-based care would help prevent elderly patients from going into nursing homes or being admitted to the hospital, particularly because they would rather be at home if possible. Grassley said one estimate suggests such a program could delay or eliminate nursing facility or hospital admissions for 5,000 patients, saving $60 million a year. It could also help keep some seniors off of Medicaid, according to the announcement.

“Allowing seniors to age in place, to stay in their homes as long as possible, takes an enormous financial and emotion burden off of families,” Cardin said in the announcement. “As our nation continues to age and grow, our legislation will help ensure that Medicare beneficiaries are able to live fulfilled lives and successfully manage medical conditions with dignity.”

The pilot could run into problems, however, as it has not yet been tested by the Center for Medicare and Medicaid Innovation, and that organization has claimed that such a measure is outside their scope of authority, according to an article from The Hill. The upfront costs and expansion of Medicare offerings could also run into opposition from Republicans in Congress as Grassley and Cardin court additional cosponsors for the measure.

The ongoing debate around repealing the Affordable Care Act and what exactly comes after could also stymie the pilot. Though GOP leaders continue to push for a quick repeal of the ACA, their replacement plans remain in flux.