House extends Medicare authority for hospital at home care for five years

The House of Representatives votes overwhelmingly on Wednesday to extend Medicare authority to fund acute hospital level care delivered in patients' homes for five more years, approving the Hospital Inpatient Services Modernization Act of 2025 on the suspension calendar. The measure, which drew bipartisan support in the lower chamber, is expected to advance in the Senate where lawmakers have signaled similar backing.

Hospital at home programs were expanded during the Covid pandemic as a pragmatic response to overwhelmed inpatient wards and spikes in demand. The temporary authority allowed hospitals and clinicians to bill Medicare for services provided in patients' homes that meet hospital level acuity, ranging from intravenous therapies to remote monitoring and in person nursing care. Proponents say the extension preserves payment certainty for providers and patients, and sustains a model that can free inpatient beds and reduce some costs for the health system.

Public health officials and hospital leaders argue that the policy offers concrete benefits for capacity management, especially in regions that face recurrent surges in demand or chronic bed shortages. By shifting appropriate acute care to well supported home settings, hospitals can reserve inpatient resources for the most complex cases. Early program evaluations during the pandemic found reduced readmissions and high patient satisfaction, though long term outcomes under broader use will need continued study.

The vote arrives amid a broader package of health funding debates in Congress, including contention over expiring Affordable Care Act subsidy provisions and other fiscal priorities. Advocates warn that the extension is temporary, and unless Congress commits to longer term policy design there will be uncertainty for hospitals, home health agencies and patients as the five year period unfolds.

Community impact will depend on how the program is implemented and resourced. Access to hospital level care at home hinges on a constellation of supports, including reliable broadband for remote monitoring, a stable home health workforce, availability of durable medical equipment and transportation for clinicians when needed. Rural communities and low income neighborhoods, where home health infrastructure is weaker and broadband coverage is patchy, risk being left behind unless federal and state efforts explicitly address those gaps.

Health equity advocates caution that without targeted investment the expansion could replicate existing disparities, concentrating services in better resourced urban and suburban markets. Workforce shortages among nurses and home health aides, and low pay for many home based caregivers, also pose barriers to scaling the model equitably. Policymakers will need to couple reimbursement authority with incentives for workforce development, quality measurement and investments in social supports that make home care safe and effective.

Senate consideration is likely to focus on oversight, quality metrics and budgetary effects. Extending reimbursement shifts where Medicare dollars flow, with implications for overall spending and for hospitals that rely on inpatient revenue. For patients and families, the promise is more care at home when clinically appropriate, but realizing that promise will require deliberate policies to ensure safety, access and fairness across communities.