Home health access could face additional pressure as the National Alliance for Care at Home raises concerns about the nationwide Medicare enrollment moratoria affecting home health agencies and hospice providers. The Centers for Medicare & Medicaid Services implemented the six-month restrictions on May 13, 2026, as part of a broader effort to address fraud, waste and abuse. The Alliance supports stronger program integrity but argues that a nationwide approach is creating unintended consequences for legitimate providers and communities that already struggle to obtain care at home.
The dispute highlights a difficult policy challenge: how Medicare can stop fraudulent organizations from entering high-risk sectors without preventing established providers from expanding services where additional capacity is needed.
Home Health Access Faces Nationwide Restrictions
CMS’s temporary moratoria apply to new Medicare enrollment applications from home health agencies and hospices.
They also cover certain non-exempt changes in majority ownership. Applications affected by the moratoria that were submitted after May 13 are denied, according to CMS. Existing enrolled providers can generally continue participating in Medicare, submitting claims and making certain enrollment changes.
The initial moratorium lasts six months, although CMS has authority to extend it in additional six-month increments if the agency determines that continued restrictions are necessary.
CMS said it implemented the policy because of significant fraud concerns within the home health and hospice sectors.
Home Health Access Was Already Limited
The National Alliance argues that the moratorium is intensifying an access problem that existed before the policy began.
According to figures cited by the organization, 38% of Medicare beneficiaries referred for home healthcare following hospital discharge through the third quarter of 2025 never received the recommended services. Rural patients experienced an even larger access gap.
The Alliance reported that beneficiaries who did not receive referred home health services experienced a 36% higher 90-day mortality rate, a 33% higher hospital readmission rate and approximately 8% higher Medicare spending over the same period compared with beneficiaries who received care.
Importantly, the Alliance acknowledges that the moratorium did not create this underlying access gap.
Its concern is that the policy may prevent experienced organizations from expanding into communities where demand already exceeds available capacity.
Rural Communities Could Feel Greater Impact
Home health services can be particularly difficult to provide in rural communities.
Providers must cover greater geographic distances while managing workforce shortages, transportation challenges and smaller patient populations.
The Alliance says established hospices and home health agencies have been asked to expand into underserved areas but cannot move forward with certain new operations because of the enrollment restrictions.
That creates tension between Medicare’s program-integrity objectives and the need to expand home-based care.
Home Health Access Depends on Provider Growth
The Alliance also argues that the moratoria affect several methods providers normally use to increase capacity.
Organizations cannot establish some new Medicare-certified operations, while proposed affiliations between hospitals or health systems and home-based care providers can also be disrupted.
Acquisitions represent another concern.
Financially struggling providers might ordinarily be acquired by larger organizations with sufficient resources to maintain or expand services. According to the Alliance, moratorium-related restrictions can complicate such transactions, potentially increasing the risk that financially distressed providers close instead.
For communities with few home health or hospice options, the loss of even one provider could have significant consequences.
Hospice Providers Report Financial Pressure
The moratoria are also creating problems for providers that invested in expansion before the federal restrictions were announced.
The Alliance cited hospices that developed inpatient facilities but are now unable to begin serving patients as planned.
Some of those facilities were partially supported through community donations, while providers hired employees in anticipation of opening operations.
Other hospices renovated unused portions of skilled nursing facilities and are continuing to pay lease expenses even though they cannot begin providing the intended services.
These examples remain claims presented by the Alliance rather than CMS findings, but they illustrate the potential financial consequences of a broad enrollment freeze.
CMS Says Moratorium Targets Medicare Fraud
CMS has presented a different policy rationale.
When announcing the restrictions, the agency said fraudulent activity involving hospice and home health providers threatened vulnerable Medicare beneficiaries and taxpayer funds. CMS described the moratoria as a temporary measure intended to stop questionable new providers from entering Medicare while federal authorities strengthen program-integrity controls.
Enrollment moratoria are not unprecedented.
CMS previously imposed geographically targeted restrictions on home health agencies and ground ambulance suppliers between 2013 and 2018. Those actions affected locations including parts of Florida, Texas, Michigan and New Jersey.
The 2026 policy differs because it applies nationally to both home health and hospice enrollment.
Home Health Access Needs Targeted Oversight
The National Alliance is urging CMS to replace the blanket nationwide moratoria with more targeted enforcement.
The organization argues that CMS already has tools capable of identifying and removing problematic providers, including enhanced screening, surveys, medical review, audits, revocation authorities and the Review Choice Demonstration.
The Alliance has previously supported targeted enrollment restrictions in areas where evidence demonstrates concentrated fraud. Its objection is primarily to nationwide restrictions that apply equally to markets with very different fraud and access conditions.
Program Integrity and Access Need Balance
CMS and home-based care advocates largely agree on the underlying objective: fraudulent operators should not be allowed to exploit Medicare or vulnerable patients.
The disagreement concerns how precisely enforcement should be targeted.
A nationwide moratorium may provide CMS with a strong barrier against new fraudulent enrollment, but it can also affect compliant organizations trying to expand into communities with legitimate unmet demand.
As the initial six-month period moves toward its scheduled conclusion, policymakers will need to assess both program-integrity results and effects on beneficiaries.
The future of home health access may depend on finding a model that aggressively identifies high-risk providers while allowing trusted organizations to expand where patients need additional home health and hospice capacity. Targeted analytics, enhanced screening and risk-based oversight could ultimately offer a path toward protecting Medicare without unnecessarily restricting access to care.
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