Hospital at Home for Medicaid Enrollees: Evidence Roundup

Blog
Logan Kelly, Center for Health Care Strategies

In recent years, home-based medical care programs have grown significantly, driven in part by efforts to improve outcomes and address gaps in care for individuals with functional limitations. Hospital at home programs provide acute care in home settings — either as an alternative to traditional hospital admission or to facilitate early hospital discharge. Hospital at home programs expanded under the Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCAH) initiative, launched in November 2020 to support hospitals during the pandemic and are currently authorized through September 30, 2025.

While most evidence on hospital at home programs has focused on Medicare enrollees — who make up the majority of participants in AHCAH — 12 states provided Medicaid reimbursement for hospital at home services under AHCAH. However, uptake for these services among Medicaid enrollees has been limited, largely due to uncertainty about the initiative’s extension. This evidence roundup specifically highlights evidence and resources aimed at tailoring these programs for Medicaid enrollees, including individuals dually eligible for Medicare and Medicaid.

How does hospital at home work?

In hospital at home programs, patients typically receive daily in-person visits from a physician or other provider, based on need, coupled with on-demand virtual or audio connections with a care team. Hospital-level services delivered in the home include medical care, intravenous therapies, blood tests, ultrasound, and respiratory therapies. Recent innovations in virtual care and remote monitoring tools, such as digital sensors, have led to greater reliance on these technologies, with nurses assuming larger roles in managing in-person care.  

The first published study of a United States hospital at home program was in 1999. Since then, some of the most robust implementations of this model have occurred within the Veterans Health Administration and through Medicare Advantage plan financing. Hospital at home services may be part of a larger continuum of home-based care, including home-based primary care models.

What is the policy landscape for hospital at home?

The AHCAH initiative was launched by CMS during the COVID-19 public health emergency. It has been extended multiple times and is currently set to expire on September 30, 2025. Through this initiative, CMS has granted waivers to individual hospitals to provide hospital at home services for Medicare fee-for-service and non-managed care Medicaid beneficiaries. Specific requirements include two daily in-person visits by registered nurses or community paramedics and immediate on-demand remote audio connections with care team members. Hospitals receive the same reimbursement levels for inpatient care as for hospital at home.

As of April 2025, 398 hospitals across 39 states have received waivers to participate. Only 12 state Medicaid agencies pay for hospital at home care for Medicaid fee-for-service enrollees, including Arizona, Arkansas, Massachusetts, Michigan, New York, New Jersey, North Carolina, Oregon, Oklahoma, South Carolina, South Dakota, and Texas. While there have not been specific evaluations of the outcomes of Medicaid enrollees in AHCAH, the broader body of evidence on hospital at home programs and on the outcomes for Medicare enrollees points to the potential for these programs in Medicaid. A recent evaluation of ACACH impacts on Medicare enrollees, for example, reported positive results related to quality of care, patient and provider experience, and Medicare spending — including lower mortality rate than the inpatient comparison group based at brick-and-mortar hospitals. 

What is the evidence behind hospital at home?

There is strong evidence on the hospital at home programs, including outcomes such as improved patient and caregiver experience, lower mortality, lower readmission and costs, lower complications rates, and improved health outcomes for specific conditions. The following resources provide summaries of the evidence base. While most evidence on these programs has focused on Medicare enrollees, the resources here emphasize impacts on Medicaid enrollees, including dually eligible individuals.

What do hospital at home programs look like in practice?

Implementation Resources

Resource centers with implementation tools include the Hospital at Home Users Group Technical Assistance Center and the Rural Home Hospital Implementation Roadmap. In examining implementation issues, stakeholders may look to address challenges that can arise including those related to caregiver burnout, logistic challenges in coordinating staff, remote monitoring, establishing payment rates, and addressing health-related social needs.

Share your resources and tools related to Hospital at Home programs

Do you have a resource or emerging best practice related to Hospital at Home programs for Medicaid enrollees? Share your experience with the Playbook. We are interested in growing our library of evidence and implementation best practices to help those in the field strengthen and build successful programs in communities across the nation.