A Medicare patient advocate stunned members of a Senate panel Tuesday by declaring that Medicare has the legal authority to cover large amounts of home care for patients, for extended periods.
Judith Stein, executive director of the Center for Medicare Advocacy in Willimantic, Connecticut, testified at a Senate Finance health subcommittee hearing that the Centers for Medicare and Medicaid Services discourages home care agencies from providing services over long periods by misleading the public and using an incentive system that favors short-term use of the services.
But, it's "a myth that this is a short-term, acute care benefit," Stein said. "CMS says it all the time. We have corrected myriad handbooks and pamphlets that come from CMS to indicate that this is a short-term benefit, when it's not. That myth really needs to be dispelled."
Sen. Catherine Cortez Masto, D-Nev., asked Stein whether it was really true that, if Medicare was implementing home care coverage benefits correctly, her own mother's first cousin might be able to avoid selling his home to raise $56,000 to pay to enter an assisted living facility.
"Yes," Stein said. "It's definitely part of the challenge."
What It Means
An experienced Medicare attorney told senators this week that Medicare can pay for enough home care to keep many older people out of assisted living facilities.
When Cortez Masto asked whether the other hearing witnesses or anyone else in the hearing room disagreed with Stein, no one said anything.
The Background
Congress tried to keep Medicare from crowding out private long-term care insurance programs by limiting it to covering acute health care.
Stein argued that changes Congress made in 1980 and 1997 eliminated home health visit caps and made it clear that Medicare enrollees could get extensive coverage for necessary home care visits.'
"Federal regulation and Medicare policy reiterate that there is no duration of time to the Medicare home care benefit," Stein said.
