Performance Improvement 2009. Why Do Few Beneficiaries Enroll in the Home Health Independence Demonstration; With What Experiences; How Do Home Health Agencies View the Homebound Restriction?


The study explored the reasons for unexpectedly low participation in the demonstration. The demonstration was intended to test the effects of deeming severely disabled beneficiaries as homebound to meet requirements for eligibility to receive Medicare home health services. The study relied on interviews with a broad range of sources, a survey of home health agencies in the demonstration states, and an analysis of Medicare claims and routinely collected assessment data.

Researchers identified a number of barriers that apparently hindered a full test of the demonstration concept. A majority of home health agencies declined to participate and some beneficiaries who were offered enrollment declined to participate. Extensive eligibility criteria of the enabling law could have targeted people too severely disabled to take advantage of the waiver. Clarifications to the homebound eligibility criteria of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 likely reduced the restrictiveness of the homebound eligibility criteria.

Report Title: Evaluation of the Home Health Independence Demonstration: Barriers to a Successful Experiment Were Multifaceted, and Difficult Policy Issues Remain

Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Ann Meadow, 410-786-6602
Performer: Mathematica Policy Research, Inc.
PIC ID: 8952

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"PerformanceImprovement2009.pdf" (pdf, 1.26Mb)

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