Medicare at Home Act
- Sponsor
- Rep. Dingell, Debbie [D-MI-6]
- Committees
- Ways and Means Committee (primary)
- Last action
- Aug 3, 2026
Bottom line
The 'Medicare at Home Act' creates a new, capped Medicare benefit to cover personal home care services, aiming to help beneficiaries age in place and reduce family caregiver burden, financed by adjusted Part B premiums.
What it actually does
This bill establishes a new Medicare Part B benefit for home care services, covering assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) for eligible beneficiaries, capped at 20 hours per week. It requires a physician-certified plan of care and mandates a reasonable wage floor for home care workers furnishing these services. The benefit would be financed through adjustments to Medicare Part B premiums.
Proponents argue
Proponents argue that the bill addresses a critical gap in Medicare coverage, allowing millions of beneficiaries to receive needed personal care at home, which aligns with the vast majority's preference to age in place. They contend it reduces out-of-pocket costs, prevents beneficiaries from spending down into Medicaid, and could lower overall healthcare system costs by preventing avoidable hospitalizations and institutionalization. Additionally, it supports unpaid family caregivers and ensures home care workers receive a reasonable wage.
Opponents contend
Opponents might raise concerns about the significant new costs to the Medicare program and the potential for increased Part B premiums for all beneficiaries, especially given the broad eligibility criteria. They may also question the administrative burden of establishing a new payment methodology and regulatory framework for home care services, as well as potential challenges in workforce availability and quality control for home care workers.
The bill is concise and relatively easy to read, allowing for a quick understanding of its core provisions.
Section 2
Congressional Findings on Home Care Need
This section outlines Congress's findings, stating that over 10 million Medicare beneficiaries need assistance with daily living, Medicare currently lacks long-term home care coverage, and most people prefer to age at home. It highlights the financial burden on families and the economic value of unpaid care, arguing that a modest home care benefit would address these issues.
Supporters argue
Supporters use these findings to establish the urgent need and broad public support for a Medicare home care benefit, framing it as a cost-effective solution that aligns with beneficiary preferences and addresses caregiver strain.
Critics contend
Critics might acknowledge the stated needs but argue that the proposed solution's costs or design may not be the most effective or fiscally responsible way to address them.
Tradeoffs
This section frames the policy choice by balancing the recognized need for home care and public preference against the fiscal implications of expanding Medicare benefits.
Section 3(a), amending Section 1861 of the Social Security Act
Establishment and Definition of Home Care Services
This provision defines 'home care services' as assistance with activities of daily living (e.g., bathing, dressing) and instrumental activities of daily living (e.g., meal preparation, medication reminders, light housekeeping directly related to health and safety). These services must be furnished in an individual's home by a home care worker under a physician-established plan of care. It explicitly caps services at 20 hours per week and distinguishes them from existing home health services.
Section 3(b), amending Section 1832(a)(2) of the Social Security Act
Inclusion of Home Care Services in Medicare Part B
This section formally adds 'home care services' (as defined in the new Section 1861(ooo)) to the list of services covered under Medicare Part B. This is the statutory mechanism for making the new benefit available to eligible beneficiaries, integrating it into the existing Medicare framework.
Section 3(c), amending Section 1833 of the Social Security Act
Establishment of Home Care Payment Methodology and Wage Floor
This provision directs the Secretary to establish a payment methodology for these new home care services. Crucially, it mandates that this methodology must reflect a 'reasonable wage floor' for home care workers providing the services. This ensures that the workers providing direct care are compensated fairly, addressing concerns about low pay in the care sector.
Section 4
Eligibility Criteria for Home Care Services
This section defines who is eligible for the new home care benefit. Individuals must be entitled to Medicare Part A or enrolled in Part B, certified by a physician as needing assistance with at least two activities of daily living (ADLs), two instrumental activities of daily living (IADLs), or one of each. Additionally, beneficiaries cannot simultaneously receive duplicative long-term services and supports through a State Medicaid plan or waiver.
Section 6
Financing Through Part B Premium Adjustment and Actuarial Report
This section mandates that the Secretary adjust the monthly Medicare Part B premium to cover the additional actuarial cost of the new home care benefit, subject to the standard subsidy schedule. It also requires the Chief Actuary of CMS to submit an estimate of the per-beneficiary premium impact to Congress within 180 days of the Act's enactment.
Section 7
Regulatory Authority and Effective Date
This section directs the Secretary of Health and Human Services to issue regulations within one year of enactment to implement the Act, including standards for home care worker qualifications and agency enrollment. The amendments made by the Act will apply to services furnished on or after the first day of the first plan year beginning more than two years after the date of enactment.
To be eligible for home care services, an individual must be certified by a physician as requiring assistance with not fewer than 2 activities of daily living, 2 instrumental activities of daily living, or 1 activity of daily living and 1 instrumental activity of daily living.
Section 3(a)(3) and Section 4(2)
Why it matters:This is standard legislative practice to define eligibility criteria precisely, ensuring the benefit is targeted to a specific level of need.
Case for: Supporters argue that this specific threshold ensures the benefit is directed to individuals with a demonstrable need for personal care, preventing overutilization and managing program costs by focusing on those with significant functional limitations.
Case against: Critics might contend that this specific threshold could exclude individuals with substantial, but slightly less severe, needs who could still greatly benefit from home care, potentially creating a 'cliff effect' where marginal differences in functional ability lead to complete exclusion.
Estimated impact: This criterion significantly shapes the eligible population, potentially impacting millions of Medicare beneficiaries by either including or excluding them based on their functional assessment.
Assistance with instrumental activities of daily living (IADLs) includes 'light housekeeping directly related to the health and safety of the individual.'
Section 3(a)(1)(B)
Why it matters:This is a common legislative technique to narrow the scope of a benefit, preventing it from becoming overly broad or covering services not directly tied to health outcomes.
Case for: Proponents argue that this ensures the home care benefit remains focused on essential services that directly impact a beneficiary's health and safety, preventing the program from covering general household maintenance that is not medically necessary.
Case against: Critics might argue that a broader interpretation of 'light housekeeping' could significantly improve a beneficiary's quality of life and ability to remain at home, and that overly strict interpretations could limit the practical utility of the benefit for those who need more comprehensive support.
Estimated impact: This specific wording limits the scope of IADL assistance, potentially reducing the overall cost of the benefit and focusing resources on critical needs, but also potentially limiting the comprehensiveness of care for some beneficiaries.