Medicare Settlement Could Increase Coverage of In-Home Care

Caregivers who are trying to get Medicare coverage for home health care for their elderly loved ones have long been caught in a Catch-22. Short-term care, in-home care is covered, but only for a limited period of time and only if the care will help improve the patient’s medical condition or ability to function. If the condition is chronic or not getting better, Medicare would not pay for care, regardless of necessity of the services, citing an “improvement standard.”

But all of that may change.

The proposed settlement of a nation-wide, class action lawsuit, Jimmo v. Sebelius, which challenged that “improvement standard,” would significantly expand coverage of therapy and skilled nursing services for Medicare beneficiaries. Under an agreement reached in October, Medicare would pay for skilled therapy or nursing care to maintain the patient’s current condition or prevent or slow further decline. A Fairness Hearing to determine final approval of this agreement is being held on January 24 in U.S. District Court.

Experts are praising this settlement for both its cost-effectiveness and compassion. Articles in the New York Times, USA Today, and other media outlets, quote leaders discussing the many benefits of this change.

Don Berwick, former administrator of the Centers for Medicare & Medicaid Services, said in a Nov. 1 USA Today article: "I don't know that you can predict the costs, but I think they did the right thing. Medicare exists to provide people with the care they need."

We couldn’t agree more.

For more information on this issue, visit the Center for Medicare Advocacy.