U.S. Extends Hospital-at-Home to 2030, Anchoring Home-Based Acute Care as Core Healthcare Infrastructure

The five-year U.S. extension through 2030 marks the first true transition of hospital-at-home from emergency waiver to permanent care infrastructure. (Source: Pexels)

The U.S. House of Representatives has unanimously approved a five-year extension of Medicare waivers for hospital-at-home programs, pushing the expiration date to September 30, 2030. The move provides the longest period of regulatory certainty since the initiative was launched during the COVID-19 pandemic and signals a structural shift in how acute care is delivered in the United States.

The legislation allows hospitals to continue providing inpatient-level care in patients’ homes by waiving selected facility and staffing requirements. The bill now advances to the Senate and is widely expected to pass, securing policy stability for more than 400 hospitals across over 140 health systems currently operating hospital-at-home programs.

Regulatory Certainty Unlocks Scale

Hospital-at-home programs were previously extended through a series of short-term authorizations, with the most recent set to expire in early 2026. Industry groups argued that regulatory uncertainty discouraged capital investment, delayed workforce planning, and slowed program expansion.

The American Hospital Association cited a brief suspension during a recent government shutdown as evidence of the model’s growing operational importance, describing it as a “capacity bind” for hospitals already facing staffing shortages and high occupancy rates.

The new legislation also directs the Centers for Medicare & Medicaid Services (CMS) to expand data collection on quality indicators, including readmissions, mortality, staffing levels, and hospital transfers—laying the groundwork for standardized oversight and long-term reimbursement models.

From Emergency Measure to Economic Strategy

While hospital-at-home gained visibility during the pandemic, the concept is not new. Johns Hopkins University School of Medicine began developing the model in the 1990s, demonstrating that selected patients could safely receive acute care at home. COVID-19 accelerated adoption by exposing structural inefficiencies in hospital-centric care delivery.

Since then, evidence has reframed hospital-at-home as an economic lever rather than a niche service. A 2024 CMS evaluation found lower mortality rates and reduced post-discharge costs compared with traditional inpatient care. Johns Hopkins reports cost savings of 19% to 30%, while Atrium Health estimates its program could free up approximately 10% of inpatient beds.

Major health systems, including Mayo Clinic and Cleveland Clinic have scaled programs nationally, while non-traditional entrants—such as Best Buy—have entered the market to provide logistics, monitoring, and in-home technology.

A $265 Billion Care Shift

The economic implications extend well beyond individual hospitals. McKinsey & Company estimates that up to $265 billion in care, nearly 25% of total Medicare spending, could shift from hospitals to the home without compromising quality or access.

Demographics reinforce the trend. The population aged 65 and older is projected to rise sharply over the next two decades, intensifying demand for models that enable aging in place while reducing institutional strain. Hospital-at-home programs also lower exposure to hospital-acquired infections, which affect roughly one in 31 inpatients daily and cost tens of billions of dollars annually in the U.S.

Capital markets have responded accordingly. Investment in health-at-home solutions reached $4.7 billion in 2021, more than double the prior year. Medically Home, backed by Baxter International, has raised $275 million and merged with DispatchHealth, creating one of the largest home-based acute care platforms in the country.

Global Evidence Strengthens the U.S. Case

Although the legislation is U.S.-specific, international adoption has helped validate scalability. Australia’s state of Victoria operates the world’s most mature hospital-at-home system, with all public hospitals participating and approximately 6% of hospital bed-days delivered at home. For certain conditions, adoption rates exceed 50%.

The UK’s National Health Service has also expanded hospital-at-home services, reporting thousands of hospital bed-days saved annually while developing national benchmarking frameworks. European countries, including France and Spain, have maintained home hospitalization federations for decades.

These models highlight a critical enabler: reimbursement parity. Where home-based acute care is paid at rates comparable to inpatient care, adoption accelerates.

Execution Risks and Technology Gaps

Despite momentum, implementation remains complex. Establishing hospital-at-home programs requires significant investment in logistics, clinical workflows, remote monitoring, and coordination across nursing, pharmacy, and emergency services. Providers must also navigate state-level regulatory requirements layered on top of federal rules.

Private payer participation lags Medicare adoption, with insurers seeking stronger evidence on quality assurance and fraud prevention. While 65% of private payers plan to incorporate AI into utilization management within five years, only 11% of providers report similar readiness, citing cybersecurity, infrastructure, and budget constraints.

Still, consolidation within the sector suggests confidence in long-term viability rather than retreat.

A Structural Redefinition of the Hospital

The five-year extension through 2030 marks a turning point. Hospital-at-home is no longer positioned as a supplemental service, but as a core component of future healthcare systems—reshaping cost structures, workforce deployment, and capital allocation.

For policymakers, the model aligns with the principles of value-based care and cost containment. For providers, it offers flexible capacity without physical expansion. For patients, it redefines where acute care can safely be provided.

The question facing U.S. healthcare is no longer whether hospital-at-home works, but how quickly systems can adapt their operating models to make it scalable, standardized, and sustainable.

🚀 Connect with Global Leaders in Aging & Care Innovation!

Sourcingcares links international partners in aging care, long-term care, and health technology, fostering collaboration and driving solutions for a changing world. Our initiatives include Cares Expo Taipei, where the future of elder care takes shape!

🔗 Follow us for insights & opportunities:

📌 Facebook: sourcingcares

📌 LinkedIn: sourcingcares

📍 Explore more at Cares Expo Taipei!

Source: Healthcaredive