Hospitals and tech leaders push Congress for a five-year extension of hospital at home

A coalition of more than 140 healthcare organizations is urging Congress to preserve and expand one of the pandemic’s most visible experiments in care delivery: the Hospital at Home waiver. In a letter sent in early September, the signatories pressed lawmakers to grant a five-year extension of the program, which allows hospitals to deliver acute-level care in patients’ homes under Medicare reimbursement rules.

“This care delivery model has been a game changer for patients, hospitals, and communities,” the letter stated. “Extending the waiver will provide stability for programs and allow continued innovation in this space.”

The plea comes as Congress debates a raft of healthcare provisions set to expire this year. Without action, the current waiver authority—first authorized under the COVID-19 public health emergency and extended temporarily in 2023—will lapse on December 31, 2024. The coalition includes health systems, digital health vendors, trade associations, and patient advocacy groups.

The waiver’s evolution

Hospital at Home, once a niche model tested by a handful of academic centers, surged during the pandemic as hospitals scrambled to free up beds and limit infection risk. The Centers for Medicare & Medicaid Services (CMS) used emergency authority to reimburse inpatient-level care provided in residential settings, provided hospitals met strict monitoring and staffing requirements.

By October 2024, 366 hospitals have participated in the initiative, serving over 31,000 patients in home settings across 39 states. Advocates say the program has reduced costs, improved patient satisfaction, and avoided unnecessary admissions. But critics have raised concerns about oversight, equity, and the long-term viability of shifting acute care away from brick-and-mortar facilities.

Congress responded in 2023 with the Hospital Inpatient Services Modernization Act, which extended the waiver for two years but fell short of providing the long-term certainty hospitals wanted. The new industry letter signals growing urgency as the clock runs down.

Why the push matters now

For health systems investing heavily in digital monitoring, telehealth infrastructure, and workforce training, a short-term extension is insufficient. “Hospitals cannot plan and allocate resources effectively if they are unsure whether the waiver will exist in 12 months,” the coalition argued.

Lawmakers have shown bipartisan interest in the concept. Rep. Brad Wenstrup (R-Ohio) and Rep. Earl Blumenauer (D-Ore.) introduced bills in recent sessions to extend or expand the program. But the politics of Medicare spending—and skepticism from some physician groups and rural advocates—may complicate a smooth renewal.

“The evidence shows that the Acute Hospital Care at Home (AHCaH) model is safe, effective, and cost-efficient—key reasons it has earned strong bipartisan support,” said Chelsea Arnone, Director of Federal affairs at CHIME. “Extending the waiver allows our members to deliver high-quality care beyond hospital walls, expanding patient choice and strengthening community care.”

Industry context

Hospital at Home sits at the intersection of multiple industry trends:

Digital health adoption: Remote monitoring devices and AI-assisted triage tools have matured rapidly, making home-based acute care more feasible.

Workforce shortages: Nursing leaders warn that caring for patients in homes requires rethinking staffing models. Some unions argue that the model could worsen burnout by stretching clinicians across wider geographies.

Cost pressures: Kaufman Hall’s latest hospital reports show financial performance has stabilized in 2025, though margins remain below pre-pandemic levels. Proponents argue that Hospital at Home helps reduce readmissions and unnecessary inpatient days, creating downstream savings.

Other countries, including Australia and the United Kingdom, have piloted similar models, often as part of broader national health service reforms.

The road ahead

The letter’s authors frame the five-year extension as essential breathing room for the model to mature. They point to growing patient demand and cite evidence that many patients prefer recovering at home rather than in institutional settings. Still, watchdog groups caution that strong regulatory guardrails are needed to ensure quality and prevent fraud.

A September 2024 CMS study found that beneficiaries who received care under the Hospital at Home initiative generally had lower mortality rates than their brick-and-mortar inpatient counterparts, along with lower Medicare spending in the 30-day post-discharge period. Patients and caregivers also expressed predominantly positive experiences with the program.

Recent legislative momentum has been encouraging. The House Committee on Energy and Commerce forwarded H.R. 7623, the Telehealth Modernization Act of 2024, by a unanimous 41-0 vote on September 18, 2024, which includes a five-year extension of the Hospital at Home waiver flexibilities.

Whether Congress acts in time may depend on the broader legislative climate. With election-year politics heating up and competing demands on Medicare dollars, the Hospital at Home waiver will have to compete with other healthcare priorities.