The state of Missouri requires Medicaid beneficiaries to be "confined to the home" in order to receive home health services provided under its Medicaid program. While this so-called "homebound" rule has been required by statute for home health services in Medicare since the beginning of the program, the Medicaid statute has never had such a requirement. In fact, the absence of a "homebound" requirement in Medicaid has been an important feature of that program for those dually-eligible for Medicare and Medicaid who may be denied home health services under Medicare for failure to meet the homebound standard.

The Centers for Medicare & Medicaid Services (CMS) has informed the Director of Missouri's Department of Social Services that the state is out of compliance with Medicaid law and that it will be sanctioned by the withholding of a portion of the federal share of payments until it comes into compliance.

This Alert focuses on the homebound issue, on CMS's legal rationale for sanctioning Missouri and on the important role of the advocacy community in bringing pressure to bear on Missouri to change its policy and on CMS to press the state to act.