Last week, I wrote a couple of posts regarding Medicaid, the Affordable Care Act/insurance premium subsidies and the government shutdown. The second of the two posts contained a quick summary of the shutdown impact on Hospital-at-Home programs. https://rhislop3.com/shutdown-is-over-the-pieces/ This post elaborates further on the Hospital-at-Home program, the end of the waiver, the end of the shutdown, and what may happen next to the program.
Program Expiration and Immediate Impacts
The bill that ended the government shutdown extended the Medicare Hospital at Home program, allowing it to continue until January 30, 2026. This extension was critical because the program’s waivers had expired on September 30, and the shutdown had caused many hospitals to pause or scale back their operations and forced them to transfer patients back to the hospital.
The Centers for Medicare & Medicaid Services (CMS) established the AHCAH program in 2020, during the COVID-19 pandemic, enabling CMS-approved hospitals to deliver hospital-level care in patients’ homes for Medicare and Medicaid fee-for-service beneficiaries. By September 2025, a total of 419 hospitals in 39 states had received CMS approval to participate, though not all implemented operational programs.
Upon the program’s expiration, CMS directed participating hospitals to discharge patients or transfer them back to traditional inpatient settings. Additionally, CMS stopped accepting new waiver applications. Guidance released on October 1 clarified that hospitals found noncompliant with the Physical Environment requirement—which had previously been waived—would need to submit a formal plan of correction, typically within 60 days.
Program Achievements Over Four Years
Throughout its four-year duration, the federal government reimbursed more than 330 hospitals under the AHCAH initiative. These hospitals remotely monitored thousands of clinically stable patients at home, thereby optimizing hospital bed utilization and enabling higher acuity care in domestic settings. The program’s expiration, resulting from a congressional deadlock over enhanced Affordable Care Act subsidies and the subsequent government shutdown, has raised concerns among hospital administrators that future participation may decline. Notably, studies have generally shown lower mortality rates among patients receiving hospital-at-home care compared to those treated in traditional facilities. A good, simple explanation of the Hospital-at-Home program is available here: understanding-the-hospital-at-home-program-infographic
Congressional Extension History
Since its launch in November 2020, during the height of the COVID-19 pandemic, Congress extended the hospital-at-home waivers multiple times: first for two years in 2022, then for an additional 90 days at the end of 2024, and again in March 2025 as a temporary measure until September 30, 2025.
Pending Legislation and Future Direction
The Telehealth Modernization Act, a bipartisan bill introduced in both chambers of Congress, aims to extend the hospital-at-home waiver for five additional years, through the end of 2030. The bill also requires CMS to conduct a comprehensive evaluation of the program.
Another legislative effort, the Hospital Inpatient Services Modernization Act (H.R. 4313 / S. 2237), introduced by Representatives Vern Buchanan (R-Fla.), Lloyd Smucker (R-Pa.), Dwight Evans (D-Pa.), and Senators Tim Scott (R-S.C.) and Raphael Warnock (D-Ga.), proposes a five-year extension of the AHCAH program through 2030. This act calls for the Department of Health and Human Services to thoroughly evaluate home-based care versus traditional inpatient care across quality, patient satisfaction, and readmission metrics. Based on these findings, CMS would develop and implement formal health and safety standards to ensure the integrity of hospital-at-home services.
Funding and Reimbursement Mechanisms
Hospital-at-home care receives funding primarily through a mix of federal and private insurance, with the Medicare AHCAH waiver authorizing reimbursement at standard inpatient rates for eligible home-based services. Some states provide additional Medicaid reimbursement, and a blend of public and private insurance, along with out-of-pocket payments, may be used to cover related costs.
Medicare:
- AHCAH Waiver: The central funding mechanism, permitting hospitals to receive reimbursement equivalent to inpatient stays for qualified patients since November 2020.
- Medicare Advantage: Some hospital-at-home programs are supported by Medicare Advantage plans, which align well with this care model.
Medicaid:
- State Reimbursement: Twelve states have provided Medicaid reimbursement under the AHCAH program for hospital-at-home services.
- State Waivers: Certain services are funded through state-specific Medicaid waivers, targeting particular populations.
Recent Developments
Following the conclusion of the government shutdown, some hospital-at-home programs, including Virtua Health in southern New Jersey, have resumed operations. However, the future of hospital-at-home initiatives now depends on prompt legislative action to renew the lapsed program waiver and secure the continuity of these innovative care models. Virtua Health Resumes Hospital-at-Home Program Following Government Shutdown