Evaluation of the Home Health Independence Demonstration: Barriers to a Successful Experiment Were Multifaceted and Difficult Policy Issues Remain

The Medicare home health benefit was originally designed to meet an individual’s post-hospitalization needs. When the legislation was written, a beneficiary could receive home health care only after a hospital stay. The homebound requirement was instituted as a cost-containment measure—once a beneficiary was well enough to travel, the beneficiary would receive care in an ambulatory setting. Over the years, the benefit was changed so it is no longer just a post-hospitalization benefit, but the homebound requirement has remained in place.