Missouri’s Department of Social Services has learned that it will be sanctioned by the Centers for Medicare & Medicaid Services (CMS) for requiring that consumers be “confined to the home” to qualify for Medicaid-covered home health services.

Requiring someone to be homebound in order to receive home health services covered by Medicaid violates federal Medicaid law as interpreted by the Olmstead Update #3 (pdf), issued by the federal Medicaid agency after the Supreme Court’s 1999 Olmstead decision.

“We are very pleased that CMS has protected Medicaid recipients by verifying that the more restrictive Medicare homebound requirement does not apply to Medicaid,” said Vicki Gottlich, LLM, JD, senior policy attorney, at the Center for Medicare Advocacy (CMA).

“Their action ensures that people will get the home health services they need,” she said.

In a February 26 letter (pdf) to the state’s social services department’s director, CMS said it will withhold a percentage of Missouri’s federal share of Medicaid dollars unless the state submits a new plan or requests a hearing within 30 days.

Unlike Medicare’s homebound requirement for home health services coverage, Medicaid has never required that someone be homebound to be covered by Medicaid for home health services.

CMA reports that the law regarding Medicare’s homebound classification and the federal agency’s interpretation of it “have been softened to clarify that a person need not lose home health services merely because s/he left home for short periods of time.”

– by Deane Beebe