The U.S. Centers for Medicare & Medicaid Services’ (CMS) six-month moratoria on home health and hospice Medicare enrollment are adversely affecting access to care, as well as providers’ financial positions.
This is according to the National Alliance for Care at Home, which penned a letter to CMS Administrator Dr. Mehmet Oz containing comments on the moratoria. In addition to other issues, beneficiaries in rural and underserved areas are missing opportunities for improved access to care, the Alliance indicated.
“We share fully the Administration’s commitment to protecting Medicare and Medicaid beneficiaries, preserving the integrity of the hospice and home health benefits, and rooting out the bad actors who have exploited these programs and harmed patients, families and the Trust Funds …” the Alliance said in the letter. “In the four months the moratoria have been in effect, we have seen unintended consequences impacting these legitimate providers and beneficiary access.”
Through the third quarter of 2025, 38% of Medicare beneficiaries referred for home healthcare at hospital discharge never received those services, the Alliance reported in the letter. Rural beneficiaries faced an even greater gap.
Compared with those who received home healthcare, beneficiaries who did not have a 36% higher 90-day mortality rate, a 33% higher hospital readmission rate and approximately 8% higher Medicare spending over the same period.
“While the moratorium did not cause this access gap, it prevents those providers who are best positioned to help close these gaps from doing so,” the Alliance said. “Specifically, long-standing hospices and home health agencies with proven quality track records have been approached by these communities to extend services to these areas. They are not able to do so due solely to the moratorium.”
The moratorium is also hindering provider growth, the Alliance contends. Providers can’t expand services into underserved areas via de novos, for instance. The moratoria also have blocked hospice and home health agency affiliations with healthcare systems.
In addition, struggling providers that might otherwise have been acquired are now at risk of closure, leaving communities with fewer options for care, the Alliance contends.
Hospices that have invested in costly inpatient units — including, in some cases, facilities funded in part through community donations — could be left with empty buildings and no patients to serve. The impact extends to the workforce, as staff hired to operate these units may be left without jobs, the Alliance indicated.
Hospices that have made significant investments to renovate unused wings of skilled nursing facilities to expand inpatient care are unable to begin serving patients and must continue paying expensive monthly lease costs, further straining their finances.
The Alliance urged CMS to abandon the national moratoria in favor of more targeted approaches and enforcement methodologies that focus on fraud perpetrators rather than impacting all hospices.
‘CMS already has the tools needed to reach fraudsters,” the Alliance said in the letter. “We believe the provisional period of enhanced oversight, thorough and comprehensive survey processes, targeted medical review, audits, high-risk screening, revocation, Review Choice Demonstration (RCD) and similar authorities, including prosecutorial actions when needed, reach bad actors with greater precision.”
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