US Medicare regulatory and eligibility changes

The Centers for Medicare & Medicaid Services (CMS) has introduced several regulatory changes affecting Medicare eligibility, payment rates, and provider enrollment.

Proposed rules for 2027 include updates to home health payment rates and new eligibility restrictions for certain immigrant groups. Following the Budget Reconciliation Act of 2025, Medicare eligibility would be limited to U.S. citizens, nationals, Lawful Permanent Residents, certain Cuban or Haitian entrants, and individuals under the Compact of Free Association. Groups such as refugees, asylees, and those with Temporary Protected Status would lose Medicare eligibility.

Further developments include the permanent implementation of telehealth enrollment flexibilities, allowing some practitioners to use physical practice locations rather than home addresses for billing. Additionally, a six-month nationwide moratorium on new Medicare home health and hospice providers has been implemented to combat fraud. While intended to protect program integrity, the moratorium has raised concerns regarding potential reductions in patient access and increased wait times in underserved areas.