Medicare Coverage Continues to Shrink

Re-posting a timely article on the financial strain of Medicare and Medicaid coverage and home care industry reimbursements. There is not enough money to fully cover all elderly in need. Seniors need to understand the responsibility to privately fund some of their aging assistance to remain secure and comfortable in their homes…

The home care industry has been dealing with tremendous challenges in recent years and for those agencies and providers that rely at least in part on Medicare and Medicaid Services for reimbursements, these past several years have added to the struggles. With rate cuts of 14 percent being fully implemented over four years (completed in January, 2017), there has been talk among political leaders in Washington, DC, of even more potential cuts coming.

Now, MedPAC, or the Medicare Payment Advisory Commission, submitted its recommendations about which services may require an increase or reduction in disbursement rates. While no other sector within the health care industry was recommended for cuts, home care is once again facing the prospect of cuts to reimbursements. This could place further strain on an industry that is simultaneously becoming more important with greater demand, but also under increased pressure to raise wages for its primary employees: home care aides.

MedPAC did note that there also need to be some changes made within the post-acute care process in the United States, namely that too many entities work independently of one another whereas unity would be more efficient and effective for patients and to help reduce costs.

Broadly, changes need to be made in the post-acute care payment systems (i.e., the skilled nursing facility, home health agency, IRF, and long-term care hospital payment systems), and the cost of inaction is mounting. Ideally, the post-acute care sectors would be brought together under a unified payment system that would base payments on patient characteristics. Such a system could both lower costs and ensure access for patients who may be financially less desirable under current payment systems.

Congress is not required to adhere to all or even any of the recommendations put forth by MedPAC, and, historically speaking, they don’t tend to, either. Congress does, though, rely on these guidelines for budgeting purposes. For example, MedPAC recommends a 5% cut to reimbursements for home care, but Congress may implement something considerably less, as they’ve done in the past.

JD Miller

About JD Miller

John D. Miller is the founder/owner of Home Care Partners, LLC, a Massachusetts business providing private duty, personalized in-home assistance and companion care services to those needing help in daily activities and household functions. Phone: (781) 378-2164 Email: Website:

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