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Medicare Waiver Expires, Forcing Massachusetts Home-Hospital Programs to Shut Down

With no extension from Congress, hospitals are shifting patients back to inpatient wards.

An unused gurney rests in the emergency room hallway outside one of the treatment rooms at the Alliance Healthcare System hospital in Holly Springs, Miss., Feb. 29, 2024. Rural emergency hospitals are starting to gain a small foothold in the United States. They provide 24/7 emergency care and receive more than $3 million in federal money a year. But the catch is there are zero inpatient beds at the facilities. (AP Photo/Rogelio V. Solis)
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Overview

  • The CMS authorization for hospital-level care at home lapsed at midnight Oct. 1 alongside the federal shutdown, cutting off Medicare reimbursement for the model.
  • UMass Memorial stopped new admissions over the weekend and reduced its census to six by Tuesday, with remaining patients discharged or readmitted, according to its program director.
  • Mass General Brigham halted transfers to its home-hospital program and expects to absorb about 70 additional inpatients, warning of longer emergency-department waits and boarding.
  • State policy in Massachusetts requires commercial plans to follow CMS rules, leading MGB to discharge or return home-hospital patients even if they had commercial coverage, as eight in-state programs pause.
  • Systems nationwide also reversed course—Mayo Clinic moved patients back in Arizona, Florida and Wisconsin—while bipartisan proposals to extend the waiver remain unresolved.