CMS Imposes Nationwide Moratorium on New Home Health Agency Enrollments to Combat Fraud

The Centers for Medicare & Medicaid Services (CMS), an agency within the Department of Health and Human Services (HHS), has formally announced a significant measure in its ongoing efforts to safeguard federal healthcare programs. Effective May 13, 2026, a six-month nationwide moratorium will be imposed on the enrollment of new Home Health Agencies (HHAs) into the Medicare program. This strategic move aims to prevent and combat fraud, waste, and abuse that CMS and other law enforcement entities have consistently identified within the HHA sector, impacting Medicare, Medicaid, and the Children's Health Insurance Program (CHIP).

Statutory and Regulatory Underpinnings

This moratorium is enacted under the authority granted by Section 6401(a) of the Affordable Care Act (ACA), specifically amending the Social Security Act by adding Section 1866(j)(7). This provision empowers the Secretary to impose temporary moratoria on the enrollment of new fee-for-service (FFS) Medicare, Medicaid, or CHIP providers and suppliers when deemed necessary to combat fraud, waste, or abuse. The ACA further extends similar provisions to Medicaid and CHIP through Sections 6401(b) and 6401(c), respectively.

CMS implemented these statutory mandates through its regulations at 42 CFR 424.570. These regulations permit CMS, often in consultation with the HHS Office of Inspector General (OIG) or the Department of Justice (DOJ), to impose such moratoria if a significant potential for fraud, waste, or abuse is determined for a specific provider type or geographic area. The announced moratorium aligns directly with these established legal and regulatory frameworks.

Rationale: Persistent Program Integrity Risks in Home Health

CMS explicitly states that the decision to implement this nationwide HHA moratorium stems from a long-standing pattern of program integrity risks associated with home health services. For over two decades, HHAs have been recognized as a high-risk area for fraud, waste, and abuse. This vulnerability is attributed, in part, to low start-up costs for such agencies and the inherent nature of home-based services, which often involve minimal direct supervision of the individuals providing care. The OIG has consistently highlighted this issue, noting in 2018 that home health is a program area vulnerable to fraud, waste, and abuse.

The determination to impose this moratorium was informed by extensive data analysis. CMS reviewed both current and historical Medicare enrollment data, cross-referencing it with indicators of fraud, waste, and abuse. This analytical approach, coupled with insights from law enforcement investigations and prosecutions, reinforced the perceived need for a proactive measure like a nationwide moratorium.

CMS's Previous Use of Moratoria and HHA-Specific Safeguards

This is not the first time CMS has utilized its moratorium authority. The agency first employed this power in 2013, targeting HHAs in specific counties in Florida and Illinois, and ambulance suppliers in Texas. These regional moratoria were subsequently extended and expanded multiple times, eventually covering entire states like Florida, Illinois, Michigan, and Texas for HHAs, and New Jersey, Pennsylvania, and Texas for Part B non-emergency ambulance suppliers. While the original HHA moratoria expired in 2019, CMS announced a new nationwide enrollment moratorium for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) medical supply companies in February 2026, which remains in effect. The agency also temporarily lifted a moratorium on non-emergency ground ambulance suppliers in Texas in 2017 following Hurricane Harvey, demonstrating flexibility in response to disaster declarations.

Notably, CMS has already implemented several specific program integrity safeguards for HHAs due to their high-risk profile. HHAs are unique among most Medicare provider types in having minimum capitalization requirements, mandating sufficient funds at enrollment and for three months thereafter to ensure financial viability and prevent potential fraud stemming from underfunding. Furthermore, HHAs are one of only six provider types designated as "high" risk under CMS's application screening levels. This designation subjects them to the strictest scrutiny, including site visits and criminal background checks for owners with a 5 percent or greater stake, upon initial enrollment or ownership change.

Scope, Duration, and Exceptions

The announced moratorium is temporary, with an initial duration of six months. CMS reserves the right to extend this period in six-month increments if deemed necessary, with each extension being publicly announced in the Federal Register. A moratorium can be lifted prematurely under specific circumstances, including a presidential disaster declaration, a public health emergency, or if program safeguards are implemented to address the vulnerabilities, or if the Secretary determines it is no longer needed. Once lifted, previously affected provider types will be assigned a "high" screening level if they apply for enrollment within six months.

It is important to note that the moratorium does not apply to all situations. Specifically, it excludes: changes in practice location (unless moving into a moratorium area), changes in provider information like phone numbers or addresses, and certain changes in ownership that do not require an initial enrollment. Crucially, any enrollment applications received by Medicare contractors prior to May 13, 2026, the effective date of the moratorium, are also exempt.