10 years of continuous hospital at home funding: Congress extends waiver

The Buzz This Week 

With passage of the government spending package on February 3, Congress extended the Acute Hospital Care at Home (or simply “hospital at home”) waiver program for another 5 years, through 2030.

The hospital at home program allows hospitals to provide hospital-level care to certain patients in their homes, even though doing so would normally violate a condition of participation in Medicare and Medicaid that requires 24/7 availability of in-person nursing care.  

As of January 2026, 373 hospitals across 140 health systems and 37 states had been approved to provide hospital at home services to patients. Hospital at home has broad support from providers, patients, and caregivers. The model has demonstrated improved patient outcomes, reduced healthcare costs, and strengthened access to care for older Americans.

Congress has already extended hospital at home waivers multiple times since the program began in November 2020, during the height of the COVID-19 pandemic. Congress extended the program in 2022 for 2 years, again at the end of 2024 for 90 days, and in March 2025 as a stopgap measure until September 30, 2025.  

Why It Matters

The waiver represents a rare strategic inflection point to secure both immediate relief for capacity constraints and long-term positioning in a consumer-centric, value-based marketplace. With payment parity locked for the next 5 years, speed to scale will substantively drive ROI.

Next steps will depend on the extent to which health systems have already been delivering acute care in the home:

Scenario 1. The health system has not yet started a hospital at home program
Scenario 2. The health system has an existing program

Scenario 1. The health system has not yet started a hospital at home program

To best capitalize on the opportunity, health systems looking to develop programs should focus on the following:  

Secure leadership alignment, commitment, and visible endorsement. Early agreement on the mission, goals, success factors, and investment requirements will help overcome predictable barriers such as cultural resistance, resource allocation, and concerns over economic viability.
Build a robust business case and pro forma. The most common mistake when launching a program is under-resourcing and under-investing. This leads to an inefficient, subscale program that’s incapable of growth. A clear business case will quantify risks and benefits through scenario modeling across key variables. It will ensure stakeholders align on the program’s financial, strategic, and time-to-value impact.
Prioritize patient populations and sites for launch. Identify high-impact, clinically appropriate patient populations, and select initial hospitals at which hospital at home can demonstrate value quickly. This will build credibility, momentum, and expertise before scaling to a broader enterprise rollout.
Design the scalable operating model. Define the clinical, operational, and technical requirements needed to deliver safe and effective acute care at home, including insource and outsource decisions for key functions. This is not a minimum viable product (MVP) but the permanent, scalable, high-quality operating model.
Plan for scale and integration into a broader care at home strategy. Position hospital at home as the foundation of a broader care at home ecosystem. Once lanched, a real program will create a 24/7 clinical command center, 24/7 remote patient monitoring (RPM) automation and alerts, and 24/7 distributed care capabilities. All of these will be essential to the future healthcare delivery context. Ensure alignment with the overall enterprise strategy by incorporating change management, performance metrics, and communication strategies from the outset.

Scenario 2. The health system has an existing program

The waiver extension provides stability and allows health system leaders to invest in scaling hospital at home as a core strategic asset. Success will require substantive investment in dedicated teams, data-driven patient identification, robust financial analytics, and a robust technical and operating infrastructure to support growth. It will also require a persistent focus on continuous improvement and cultural change management, such as engaging providers, patients, and caregivers to build trust in the model.  

To grow efficiently and strategically, health systems should:

Reaffirm the strategy and business case for scale. Develop a multi-year hospital at home financial model that accounts for reimbursement pathways, backfill opportunities, and unit economics. A clear, operating “virtual P&L” linked to the annual budget process will strengthen executive alignment and ensure hospital at home is viewed appropriately as a core and enduring clinical service offering.
Redesign the care team and operating model for growth. Transition to a dedicated hospital at home care team with clear roles, scalable staffing models, and streamlined workflows to ensure readiness to safely grow from single-digit average daily census (ADC) to a “minimum viable” census of ~15 patients and beyond.
Optimize patient identification and enrollment. Develop a multi-pronged “push” and “pull” patient identification and acquisition program. Such a program leverages emerging AI patient-identification tools, electronic health record (EHR)-based provider prompting and alerts, and formalized navigator roles to capture more eligible patients and overcome workflow breakdowns and any provider hesitancy.
Invest in patient, caregiver, and clinician engagement. Build provider and patient confidence in hospital at home through standardized education, clear communication, and structured change management to boost referrals and enrollment.
Build performance management and continuous improvement discipline. Set and track key performance indicators (KPIs) across clinical, operational, financial, and experience domains with automated reporting. Use iterative improvements to remove barriers and sustain hospital at home growth without compromising quality or experience.

With the waiver extension, leading health systems across the country finally have the enduring financial certainty they need to press this new site of care further into the mainstream—further transforming how and where care is delivered.