Pulse brief · 2 cited sources · July 23, 2026
Commonwealth Fund: access to Medicare home health care is eroding
Paired issue briefs blame misaligned payment incentives, Medicare Advantage practices, and workforce shortages for declining use of a benefit many families do not understand.
The Commonwealth Fund published paired issue briefs on July 9 finding that Medicare beneficiaries, especially those with chronic health conditions, are increasingly unable to access home health services, attributing declining use of the benefit to misaligned payment and quality incentives, Medicare Advantage plan practices, and workforce shortages. Recent payment reforms favoring postacute patients with short-term needs potentially disadvantage beneficiaries with chronic conditions, cognitive impairment, behavioral health needs, or long-term maintenance requirements, and Medicare Advantage enrollees receive fewer visits, their home health providers receive lower payments, and they encounter narrow provider networks. A companion brief, drawing on 20 interviews with beneficiaries and their caregivers, found limited awareness of the benefit prior to referral, agency choice generally limited and determined by a hospital-based or primary care provider, mental health needs often present but unaddressed, and caregivers filling gaps in care delivery.
Evidence
Each statement shown below is a verified claim this source supports.
- The Commonwealth Fund published paired issue briefs on Medicare home health dated July 9, 2026.
- Medicare beneficiaries, especially those with chronic health conditions, are increasingly unable to access home health services, primarily because of misaligned payment and quality incentives, Medicare Advantage plan practices, and workforce shortages.
- Use of the Medicare home health benefit has declined in recent years despite an aging population.
- Recent home health payment reforms favoring postacute patients with short-term needs potentially disadvantage beneficiaries with chronic conditions, cognitive impairment, behavioral health needs, or long-term maintenance requirements.
- Medicare Advantage enrollees receive fewer home health visits than traditional Medicare beneficiaries, their home health providers receive lower payments, and enrollees encounter narrow provider networks.
- The Commonwealth Fund published paired issue briefs on Medicare home health dated July 9, 2026.
- Many families do not understand Medicare's home health benefit.
- The companion brief drew on 20 interviews with beneficiaries and caregivers of beneficiaries who were referred to home health services.
- The interviews found limited awareness of the benefit prior to referral, agency choice generally limited and determined by a hospital-based or primary care provider, mental health needs often present but unaddressed, and caregivers filling gaps in care delivery.