Medicare’s Rules for Disabled Seeking Home Health Services Should be Changed, Op-Ed Says

A rule that Medicare beneficiaries must be "homebound" in order to receive home health services leaves disabled patients "virtually imprison[ed]" and should be changed, Barry Corbet writes in a Denver Post opinion piece. Corbet is the former editor of New Mobility, a magazine that "covers disability culture and lifestyle." To qualify for the Medicare home health benefit, Corbet writes, recipients must require skilled care and only be able to leave their home with a "considerable and taxing effort," such as the use of canes, walkers or wheelchairs. Further, the rule requires that any "non-medical" trips from home be "infrequent and of short duration," and implies that if a patient can leave home "frequently or for lengthy periods," home health services are not necessary. Corbet writes that the Centers for Medicare and Medicaid Services (formerly HCFA) enforces the rule "aggressively," terminating home health benefits for anyone judged not to be homebound. He adds that the "cruel irony" of the rule is that it cuts off benefits to patients who "strive for maximum independence," which is "normally valued and rewarded by our culture." Those denied services often must move into a nursing home to receive the daily care they need. Others seeking to remain independent will transfer assets to family members or divorce their spouses to qualify for Medicaid, which does not have a homebound rule, shifting the cost of care from federal to state budgets. Corbet notes that by "effectively segregat[ing]" home care patients in their houses or in nursing homes, the rule conflicts with the Americans With Disabilities Act, which pushes for a "society that integrates people with disabilities." Corbet calls for support of the Medicare Homebound Clarification Act of 2001 (HR 1490), a bill introduced by Rep. Ed Markey (D-Mass.) that would eliminate the requirement that "absences from the home" be short and rare in order to qualify for home health benefits. The proposal would still require beneficiaries with disabilities to need skilled care and to find leaving the home "taxing." Corbet concludes that if the bill is enacted, "it will end Medicare's outworn dictum that people who need home care to be mobile must be barred from an active life" (Corbet, Denver Post, 7/15).