The future of hospital-at-home amid Medicaid uncertainty

Medicare has granted waivers to 256 hospitals in 37 states to conduct hospital-at-home programs, but uncertainty over Medicare's future involvement has been hindering these programs from being adopted more widely, The New York Times reported Nov. 19. 

In November 2020, Medicare officials said that while the public health emergency continued, hospitals could apply for a waiver of certain reimbursement requirements, including 24/7 on-site nursing care. 

Hospitals whose applications were approved would receive the same payment for hospital-at-home care as for in-hospital care.

This allowed hospital-at-home programs, which initially focused on treating acute illnesses like pneumonia, urinary tract infections and heart failure, to advance and treat patients for postsurgical care and cancer.

But Medicare's waivers are not permanent, and the public health emergency is set to end in January. This has caused uncertainty around whether hospitals and health systems can keep these programs alive without the waiver. 

According to a poll by the Hospital at Home Users Group, many of the groups said they were unlikely to keep offering the option if the waiver ends. Forty percent said they were unsure, and 33 percent said their programs were likely to continue.

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