Medicare Home Health Eligibility Poised to Include Occupational Therapy Starting 2026

The Medicare Home Health Accessibility Act proposes a targeted expansion of Medicare's home health benefits. Effective for services provided on or after January 1, 2026, this bill adds the need for occupational therapy (OT) as a qualifying reason for eligibility, alongside the existing criteria like needing speech therapy or skilled nursing care. The core idea is to broaden the pathway for Medicare beneficiaries to receive therapeutic services in their own homes.

Opening the Door for OT

Currently, Medicare home health services often hinge on a primary need for skilled nursing, physical therapy, or speech therapy. While occupational therapy can be part of the care plan, it typically hasn't been the sole qualifying service. Section 2 of this bill changes that. Starting in 2026, if a Medicare patient's primary need is for occupational therapy – think services helping someone regain skills for daily living after an illness, injury, or surgery, like dressing, cooking, or managing medications safely at home – they could become eligible for the home health benefit. For instance, someone recovering from a stroke might need OT to adapt their home environment and relearn tasks, potentially qualifying them for services under this change.

Real-World Impact for Patients

This shift could make a significant difference for individuals whose main barrier to independence or recovery is functional, addressable through OT. It potentially allows more people to receive necessary therapy where they live, rather than needing outpatient services or potentially delaying care. By recognizing OT as a standalone qualifying need, the bill aims to better align Medicare benefits with the diverse recovery paths and needs of beneficiaries, particularly those managing chronic conditions or recovering from specific medical events where functional skills are key.

The 2026 Rollout

With an effective date of January 1, 2026, there's lead time built in. This allows time for the Centers for Medicare & Medicaid Services (CMS) to develop regulations and guidance, and for home health agencies to prepare for potential shifts in patient intake and service provision. Integrating OT as a primary qualifier will require adjustments in assessment processes and care planning to ensure the services appropriately meet the newly eligible beneficiaries' needs under the established Medicare conditions of participation.