Medicare at Home Act

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 10020 Introduced in House (IH)]

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119th CONGRESS
  2d Session
                               H. R. 10020

To amend title XVIII of the Social Security Act to establish a Medicare
               home care benefit, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             August 3, 2026

 Mrs. Dingell introduced the following bill; which was referred to the
 Committee on Energy and Commerce, and in addition to the Committee on
   Ways and Means, for a period to be subsequently determined by the
  Speaker, in each case for consideration of such provisions as fall
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

To amend title XVIII of the Social Security Act to establish a Medicare
               home care benefit, and for other purposes.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare at Home Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) More than 10,000,000 Medicare beneficiaries need
        assistance with one or more activities of daily living, and
        current Medicare law does not cover long-term, personal care in
        the home.
            (2) The absence of a home care benefit forces beneficiaries
        and families to pay out of pocket, spend down into Medicaid, or
        forgo needed care, often at greater cost to the health care
        system through avoidable hospitalizations and
        institutionalization. Paying out of pocket for home care costs
        more than $60,000 annually.
            (3) The vast majority of people want to live and age with
        dignity in their homes when they need care, including 94
        percent of older adults, 90 percent of people with
        disabilities, and 89 percent of adults overall.
            (4) Americans overwhelmingly and strongly believe Medicare
        should cover home care services, with 93 percent of adults
        agreeing. The majority of current Medicare beneficiaries either
        believe it already does or do not know if it does or not.
            (5) A modest, capped home care benefit under Medicare would
        allow older adults and people with disabilities to remain
        safely in their homes and communities. It would also take the
        pressure off of unpaid family caregivers who now provide over
        $1,000,000,000,000 in unpaid care to the economy filling in
        gaps in the systems.

SEC. 3. ESTABLISHMENT OF MEDICARE HOME CARE BENEFIT.

    (a) In General.--Section 1861 of the Social Security Act (42 U.S.C.
1395x) is amended by adding at the end the following new subsection:
    ``(ooo) Home Care Services.--
            ``(1) In general.--The term `home care services' means the
        following services furnished to an individual in the
        individual's home by a home care worker under a plan
        established under paragraph (3):
                    ``(A) Assistance with activities of daily living,
                including bathing, dressing, toileting, transferring,
                and eating.
                    ``(B) Assistance with instrumental activities of
                daily living, including meal preparation, medication
                reminders, and light housekeeping directly related to
                the health and safety of the individual.
            ``(2) Limitations.--Home care services furnished under this
        subsection--
                    ``(A) shall not exceed 20 hours per week per
                individual; and
                    ``(B) do not include, and are separate from, home
                health services described in subsection (m).
            ``(3) Plan of care.--Home care services shall be furnished
        pursuant to a plan of care established and periodically
        reviewed by a physician (or other practitioner authorized under
        this title to establish a plan of care), which shall certify
        that the individual requires assistance with not fewer than 2
        activities of daily living, 2 instrumental activities of daily
        living, or 1 activity of daily living and 1 instrumental
        activity of daily living described in paragraph (1)(A).''.
    (b) Coverage Under Part B.--Section 1832(a)(2) of the Social
Security Act (42 U.S.C. 1395k(a)(2)) is amended--
            (1) in subparagraph (I), by striking ``and'' at the end;
            (2) in subparagraph (J), by striking the period at the end
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(K) home care services (as defined in section
                1861(ooo)).''.
    (c) Payment.--Section 1833 of the Social Security Act (42 U.S.C.
1395l) is amended by adding at the end the following new subsection:
    ``(ee) Payment for Home Care Services.--The Secretary shall
establish a payment methodology for home care services (as defined in
section 1861(ooo)) furnished by agencies or individuals enrolled under
this title, which shall reflect a reasonable wage floor for home care
workers furnishing such services.''.

SEC. 4. ELIGIBILITY.

    An individual is eligible for home care services under this Act if
the individual--
            (1) is entitled to benefits under part A, or enrolled under
        part B, of title XVIII of the Social Security Act (42 U.S.C.
        1395 et seq.);
            (2) has been certified, in accordance with section
        1861(ooo)(3) of such Act (as added by section 3), as requiring
        assistance with not fewer than 2 activities of daily living, 2
        instrumental activities of daily living, or 1 activity of daily
        living and 1 instrumental activity of daily living; and
            (3) is not, at the time Medicare home care services are
        furnished, receiving long-term services and supports through a
        State plan (or waiver of such plan) under title XIX of the
        Social Security Act (42 U.S.C. 1396 et seq.) that duplicate the
        services described in section 1861(ooo).

SEC. 5. BENEFIT AMOUNT.

    Home care services furnished under this Act may not exceed 20 hours
per week per eligible individual, as set forth in section
1861(ooo)(2)(A) of the Social Security Act (as added by section 3).

SEC. 6. FINANCING.

    (a) Part B Premium.--The Secretary shall adjust the monthly premium
under section 1839 of the Social Security Act (42 U.S.C. 1395r) to
reflect the additional actuarial cost of the benefit established under
this Act, subject to the standard subsidy schedule under such section.
    (b) Actuarial Report.--Not later than 180 days after the date of
enactment of this Act, the Chief Actuary of the Centers for Medicare &
Medicaid Services shall submit to Congress an estimate of the per-
beneficiary premium impact of the benefit established under this Act.

SEC. 7. ADMINISTRATION.

    (a) Regulations.--Not later than 1 year after the date of enactment
of this Act, the Secretary of Health and Human Services shall
promulgate regulations necessary to carry out this Act and the
amendments made by this Act, including standards for home care worker
qualifications and agency enrollment.
    (b) Effective Date.--The amendments made by this Act shall apply to
home care services furnished on or after the first day of the first
plan year beginning more than 2 years after the date of enactment of
this Act.
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