Congress Looks at Home Care Co-Pay

October 14, 2003
Congressional conferees are considering adding a co-payment for home health care to the Medicare "reform" bill, The New York Times reported today. It's currently one of the few Medicare benefits that does not carry a co-pay.

The House version of the bill would also reduce the annual update in Medicare payment rates for home health services over the next three years. The Congressional Budget Office estimates the co-pay and reduced updates would save $7 billion over 10 years.

Critics say the changes would imperil those most in need and they charge that the cost of collecting the payments would exceed the amounts collected.

Lawmakers are looking at a co-pay of about $40 to $45 for each 60-day period in which home care is provided to a Medicare beneficiary. That equals about 1.5 percent of the average cost of such care in most parts of the country.

Rep. Bill Thomas (R-Calif.) said the co-pay would deter unnecessary use of home care. The co-pay was eliminated by Congress in 1972 to encourage the use of home care instead of more expensive nursing home and hospital care.

A co-pay would encourage the chronically ill to use care "more prudently," Thomas, the chief architect of the House Medicare "reform" bill, said. But the co-pay was immediately labeled a "sick tax" by its opponents, most home care agencies and advocates for the elderly.

The Bush administration is trying to stay out of the co-pay fight and has not taken a position on it, according to Thomas A. Scully, administrator of the Centers for Medicare and Medicaid Services.

Both opponents and advocates say that a modest co-pay seems inevitable at this point and they predicted that any effort to eliminate it would touch off a major fight. Home health care workers provide a variety of services to the homebound elderly and disabled and those with chronic illnesses.

The Visiting Nurse Association said the co-pay would hit elderly women in poor health the hardest and would create "a real hardship" for many of them. Even if individuals with incomes under $12,000 per year were exempt, those with incomes of $12,000 to $15,000 would be hard-pressed to make the payment, the association said.