Pulse brief · 3 cited sources · July 23, 2026
Commonwealth Fund: Medicare home health use declines despite aging population
Paired July 9 issue briefs trace declining use to misaligned payment incentives, Medicare Advantage practices, and workforce shortages — and find many beneficiaries don't understand the benefit.
The Commonwealth Fund published paired issue briefs on July 9 examining why use of Medicare's home health benefit has declined in recent years despite an aging population. Drawing on interviews with more than 20 policy experts, home health agencies, providers, and advocates, one brief finds that payment reforms favoring postacute patients with short-term needs can disadvantage beneficiaries with chronic conditions or cognitive impairment; that Medicare Advantage enrollees receive fewer visits through narrow networks while their home health providers receive lower payments; and that workforce shortages further constrain access. A companion brief, built on 20 interviews with beneficiaries and caregivers, reports that families typically had limited awareness of the benefit before referral, valued the services highly, and filled gaps in care delivery themselves. In Health Affairs, Barbara Lyons and Jane Andrews argue that as home-based care expands — the Consolidated Appropriations Act of 2026 extended the Acute Hospital Care at Home Program through 2030 and telehealth flexibilities through 2027 — the existing benefit needs strengthening and modernizing too.
Evidence
Each statement shown below is a verified claim this source supports.
- Use of the Medicare home health benefit has declined in recent years despite an aging population.
- The Commonwealth Fund published paired issue briefs on July 9, 2026 examining the Medicare home health benefit.
- Declining access and use of Medicare home health primarily reflect misaligned payment and quality incentives, Medicare Advantage plan practices, and workforce shortages.
- The access brief drew on interviews with more than 20 policy experts, home health agencies, providers, and advocates.
- Payment reforms favoring postacute patients with short-term needs potentially disadvantage beneficiaries with chronic conditions or cognitive impairment.
- Medicare Advantage enrollees receive fewer visits than traditional Medicare beneficiaries, their home health providers receive lower payments, and enrollees encounter narrow provider networks.
- Workforce shortages further constrain access to home health services.
- The Commonwealth Fund published paired issue briefs on July 9, 2026 examining the Medicare home health benefit.
- Many families do not understand Medicare's home health benefit.
- The companion brief, based on 20 interviews with beneficiaries and caregivers, found interviewees typically had limited awareness of the benefit prior to referral, viewed the services as extremely valuable, and caregivers often filled gaps in care delivery.
- In Health Affairs, Barbara Lyons and Jane Andrews argue that as home-based models of care expand, the existing Medicare home health benefit should be strengthened and modernized.
- The Consolidated Appropriations Act of 2026 extended the Acute Hospital Care at Home Program through 2030 and telehealth flexibilities through 2027.