Medicare Home Care Eligibility Standards Unfairly Burden Family Caregivers, Think Tank Argues

McKnight’s Home Care |  By Adam Healy
 
Researchers called on the Centers for Medicare & Medicaid Services to act now to integrate more kinds of home care benefits for Medicare beneficiaries to help patients and their caregivers grappling with strict eligibility criteria and inadequate support systems.
 
“Millions of unpaid family caregivers are providing a broad range of assistance to beneficiaries as they recover from illness, move through rehabilitation or deal with chronic health challenges,” experts from the non-profit research group Aspen Institute wrote in a recent report. “Without more medical and social support from a reconfigured Medicare system, the overwhelming burden on family caregivers will only grow heavier.”
 
Medicare’s criteria for a beneficiary to be eligible for home care is too high, they argued, and unpaid family caregivers bear the greatest responsibilities caring for those that do not make the cut. Oftentimes these caregivers are forced to “spend down” to become eligible for Medicaid, whereby long-term services and supports, including home- and community-based services, are more easily accessible. 
 
By expanding Medicare’s eligibility pool and offering home care services to a greater share of the Medicare population, beneficiaries can enjoy better health outcomes, the researchers said.
“Current criteria for receiving home health Medicare services, especially the requirement that a recipient be homebound, greatly shrinks the eligible population,” they wrote. “A number of alternative eligibility guardrails, such as functional status or level of risk for potentially avoidable nursing home care, could be considered if the homebound requirement were eliminated.”
 
New systems to coordinate care between healthcare and nonmedical personal care providers should be considered by CMS, they added. Things like reimbursement for navigation services, better training opportunities for caregivers, and effective use of new technology are especially important and can make it easier for providers and caregivers to help older adults in need of home care.
 
While a one-size-fits-all solution may not be possible, current support for Medicare-funded home care is simply not enough, Aspen Institute wrote.
 
“Medicare needs to change. An aging population and the opportunities introduced by technology add to the sense of urgency,” they said. “Coupling immediate steps with longer-term strategies to respond to the needs of a changing healthcare environment can strengthen family caregiving and allow Medicare beneficiaries to remain in the safe and familiar environment of home.”