Medicare at Home Act
- Sponsor
- Sen. Kim, Andy [D-NJ]
- Committees
- Finance Committee (primary)
- Last action
- Aug 5, 2026
Bottom line
The Medicare at Home Act aims to expand Medicare coverage to include personal home care services, addressing a significant gap in current benefits and potentially shifting care from institutional settings to home-based care, funded by increased Part B premiums.
What it actually does
This bill establishes a new Medicare Part B benefit for home care services, specifically assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), capped at 20 hours per week. It requires a physician-certified plan of care for individuals needing assistance with at least two ADLs/IADLs and prohibits duplication with existing Medicaid long-term services. The benefit will be funded through adjustments to Medicare Part B premiums and includes a mandate for a reasonable wage floor for home care workers.
Proponents argue
Proponents argue that the bill addresses a critical unmet need for millions of Medicare beneficiaries who require assistance with daily living, allowing them to age with dignity in their homes. They highlight the financial burden on families and the healthcare system due to the lack of coverage, asserting that home care can prevent costly hospitalizations and institutionalization while supporting unpaid family caregivers. The inclusion of a wage floor is also seen as vital for stabilizing the home care workforce.
Opponents contend
Opponents might raise concerns about the significant new costs associated with establishing a broad home care benefit under Medicare, potentially leading to substantial increases in Part B premiums for all beneficiaries. They may also question the administrative feasibility of implementing such a large-scale program and the potential for fraud and abuse in home care settings, particularly given the delegation of a 'reasonable wage floor' to future regulation.
The bill is relatively short and straightforward, allowing for a quick and comprehensive understanding of its core provisions and implications.
Section 3(a), amending Section 1861 of the Social Security Act (42 U.S.C. 1395x)
Defines 'Home Care Services'
This provision defines 'home care services' to include assistance with activities of daily living (such as bathing, dressing, and eating) and instrumental activities of daily living (such as meal preparation, medication reminders, and light housekeeping directly related to health and safety). These services must be furnished in an individual's home by a home care worker and are explicitly stated as separate from existing home health services.
Supporters argue
Supporters argue this clear definition is essential to delineate the scope of the new benefit, ensuring it targets personal care needs distinct from medical home health services, which are already covered, thereby avoiding duplication and clarifying intent.
Critics contend
No specific opposition is typically raised against the definition itself, but rather to the overall expansion of services and its associated costs.
Tradeoffs
The provision balances the need for a broad enough definition to meet diverse personal care needs with a specific enough definition to prevent scope creep and cost escalation within the Medicare program.
Section 3(a), amending Section 1861(ooo)(2) of the Social Security Act
Caps Home Care Hours and Differentiates from Home Health
This provision limits the new home care services to a maximum of 20 hours per week per individual. It also explicitly clarifies that these services do not include, and are separate from, existing home health services described in subsection (m) of Section 1861 of the Social Security Act.
Section 3(a), amending Section 1861(ooo)(3) of the Social Security Act
Mandates Physician-Certified Plan of Care
Home care services must be furnished pursuant to a plan of care established and periodically reviewed by a physician or other authorized practitioner. This plan must certify that the individual requires assistance with at least two activities of daily living, two instrumental activities of daily living, or one activity of daily living and one instrumental activity of daily living.
Section 3(b), amending Section 1832(a)(2) of the Social Security Act
Adds Home Care Services to Medicare Part B Coverage
This provision formally amends Section 1832(a)(2) of the Social Security Act to include 'home care services' as a covered benefit under Medicare Part B. This integrates the new benefit into the existing framework for outpatient and medical services.
Section 3(c), amending Section 1833 of the Social Security Act
Establishes Payment Methodology and Home Care Worker Wage Floor
The Secretary of Health and Human Services is directed to establish a payment methodology for home care services furnished by enrolled agencies or individuals. Crucially, this methodology must reflect a 'reasonable wage floor' for the home care workers providing these services.
Section 4
Defines Eligibility for Home Care Services
An individual is eligible for home care services if they are entitled to benefits under Medicare Part A or enrolled under Part B, have been certified by a physician as requiring assistance with at least two ADLs, two IADLs, or one of each, and are not simultaneously receiving duplicative long-term services and supports through a State Medicaid plan or waiver.
Section 6(a)
Funds Benefit via Part B Premium Adjustment
The Secretary is mandated to adjust the monthly Medicare Part B premium to cover the additional actuarial cost of this new home care benefit. This adjustment will be subject to the standard subsidy schedule under Section 1839 of the Social Security Act.
Section 6(b)
Mandates Actuarial Report on Premium Impact
Within 180 days after the date of enactment, the Chief Actuary of the Centers for Medicare & Medicaid Services (CMS) must submit to Congress an estimate of the per-beneficiary premium impact of the benefit established under this Act.
Section 7
Directs Regulations and Sets Effective Date
The Secretary of HHS must issue regulations within one year to implement the Act, including standards for home care worker qualifications and agency enrollment. The benefit will apply to home care services furnished on or after the first day of the first plan year beginning more than two years after the date of enactment.
Directs the Secretary to establish a payment methodology for home care services that 'shall reflect a reasonable wage floor for home care workers furnishing such services.'
Section 3(c)
Why it matters:This is standard legislative practice to delegate specifics to agency rulemaking, allowing for flexibility to adapt to market conditions. However, it also defers the politically sensitive task of setting a specific wage level and its associated, potentially substantial, costs.
Case for: Proponents argue that delegating the wage floor to the Secretary allows for flexibility to adapt to regional economic conditions and workforce needs, ensuring the floor is truly 'reasonable' and effective without being overly prescriptive in legislation. This approach can also allow for adjustments over time.
Case against: Opponents might argue that the lack of a specific wage floor in the bill makes it difficult to accurately assess the true cost of the program, potentially leading to higher-than-expected expenditures once regulations are finalized, thus obscuring the full financial commitment.
Estimated impact: Potentially billions of dollars in increased program costs, depending on the final wage floor set by the Secretary, which will directly impact Medicare Part B premiums and federal outlays.
States that an individual is eligible for Medicare home care services only if they are not, at the time services are furnished, receiving long-term services and supports through a State plan (or waiver of such plan) under title XIX of the Social Security Act (Medicaid) that duplicate the services described in section 1861(ooo).
Section 4(3)
Why it matters:This is a common legislative mechanism to prevent 'double-dipping' or duplicative federal spending across programs. It creates a clear boundary between Medicare and Medicaid's roles in long-term care, which is a complex area of federal-state partnership.
Case for: Proponents argue this prevents wasteful spending by ensuring federal funds are not used to pay for the same services twice, and clarifies the distinct roles of Medicare (new home care benefit) and Medicaid (existing long-term services and supports), promoting fiscal responsibility.
Case against: Critics might argue this creates a complex administrative burden for states and beneficiaries to navigate, potentially leading to gaps in care or forcing beneficiaries to choose between programs rather than receiving comprehensive, coordinated support tailored to their needs.
Estimated impact: Reduces the overall cost of the Medicare home care benefit by excluding a segment of the population already receiving similar services through Medicaid, potentially saving billions in federal expenditures.