The Case for a New Medicare Benefit Covering Home- and Community-Based Services


About one in five people with Medicare have serious physical or cognitive limitations that require personal care services and supports, like bathing and meal prep, on a long-term basis. Only low-income beneficiaries eligible for Medicaid, however, can get coverage for these services.

The lack of a Medicare benefit to help pay for home- and community-based services and supports means that many seniors needing this type of care face unaffordable out-of-pocket costs.

In a new Commonwealth Fund report, Karen Davis of the Johns Hopkins Bloomberg School of Public Health and colleagues explore important considerations in offering home- and community-based services by examining Maryland’s experience with Community First Choice, a new Medicaid benefit option that allows states to cover expenses for personal care. Their analysis finds that use of paid personal assistance has averaged 29 hours per week, and the benefit has had stable per-person costs since launching in 2014. Even more important, the benefit supplements, rather than replaces, support provided by family caregivers — addressing a key policy concern.

Davis and her team have made the case for making a similar benefit available to Medicare beneficiaries without Medicaid coverage. They argue such services could promote independent living over a longer period while achieving savings relative to costly nursing home care.

Designing Medicare Home Care_1x1 Read the report