Perspectives on Medicaid Coverage for Adult Home-Based Palliative Care

The Department of Vermont Health Access (DVHA) administers Medicaid and currently reimburses for institutional palliative care (PC) for both adults and children. While home-based palliative care (HBPC) is reimbursed for pediatric beneficiaries, HBPC for adults is an uncovered service.

To assess the need for adult HBPC Medicaid coverage and evaluate barriers to providing HBPC services from the perspective of local medical professionals and home health agencies (HHAs) in the state of Vermont.

Qualitative and descriptive study.

Six clinicians from Vermont, United States, were individually interviewed. DVHA recruited 10 HHA representatives to participate in a focus group and 1 HHA representative who was unable to attend but participated in a separate interview. All participants (n = 17) received an information packet with a proposed PC service package developed prior to participation.

Recordings of the interviews and focus group were transcribed and analyzed using thematic content analysis with NVivo software (version 14). The independent coders reviewed the transcripts and identified key themes and subthemes.

Four overarching themes were identified: (1) Treatments, Purpose, and Quality of Care; (2) Interdisciplinary Team, Staffing, and Referrals; (3) Education, Communication Barriers, and Defining PC; and (4) Accessibility and HHA Financial Considerations.

Overall, clinicians and HHA representatives suggested that HBPC may provide benefit for patients through enhanced quality of life, but many believe that further education and staffing are necessary to appropriately deliver these services. Further research into Medicaid reimbursement models will be helpful to assess the feasibility of HBPC delivery.