Cone Health is ending its NC hospital-at-home program despite a Medicare waiver through 2030. Learn what it means for your coverage and care options.
Written by the licensed agents at Health Plans of NC, an insurance agency authorized by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Hospital-at-home programs let Medicare patients receive acute, hospital-level care at home, often with outcomes comparable to traditional inpatient stays.
Medicare's Acute Hospital Care at Home waiver, active through at least 2030, authorizes approved hospitals to bill Medicare for home-based acute care.
Cone Health in Greensboro recently announced it is ending its hospital-at-home program — even though its Medicare waiver remains valid — citing financial and operational challenges.
Not all North Carolina health systems offer hospital-at-home programs, and availability varies significantly by region and insurer.
If your provider ends its program, understanding your Medicare coverage options and alternatives is critical to avoiding unexpected care gaps.
A hospital-at-home program delivers acute, hospital-level medical care inside a patient's home as a direct substitute for an inpatient stay. Nurses, physicians, and care teams visit in person, while remote monitoring technology tracks vital signs around the clock.
These programs are not home health aides or standard skilled nursing visits. They are designed for conditions that would otherwise require inpatient admission—such as pneumonia, heart failure exacerbations, infections, and similar acute illnesses—and meet the same clinical standards as a hospital bed.
Research published in peer-reviewed journals, including work cited by the Centers for Medicare and Medicaid Services (CMS), has shown that outcomes for carefully selected patients in hospital-at-home programs are generally comparable to traditional inpatient care, with some studies noting lower rates of certain complications.
Medicare covers hospital-at-home care under an active CMS waiver program called the Acute Hospital Care at Home initiative. Under this waiver, approved hospitals can bill Medicare for care delivered at a patient's home at the same rate as an inpatient stay.
Congress introduced this waiver during the COVID-19 public health emergency and has extended it. As of today, October 22, 2026, the waiver is authorized to run through at least 2030, giving health systems a clear federal green light to operate and bill for these services.
From a coverage standpoint, Medicare Part A generally applies — the same benefit that covers traditional inpatient hospital stays. Your cost-sharing obligations, such as deductibles and coinsurance, would typically mirror what you would owe for an inpatient stay under your Medicare plan.
If you have a Medicare Advantage plan rather than Original Medicare, coverage depends on whether your specific plan has adopted the waiver. Not all Medicare Advantage plans in North Carolina have, and some may have stricter eligibility criteria. Always verify directly with your plan before assuming coverage.
Cone Health, a major health system based in Greensboro and serving Guilford County and surrounding regions, has announced it is discontinuing its hospital-at-home program despite holding a valid Medicare waiver through 2030. This decision highlights a widening gap between federal policy support and the on-the-ground operational reality for health systems statewide.
Running a hospital-at-home program is operationally expensive in ways that are not always obvious. Health systems must invest in remote monitoring technology, coordinate logistics for frequent in-person nurse and physician visits, maintain 24/7 response capability, and train dedicated clinical staff.
The Medicare reimbursement rate, while theoretically equivalent to an inpatient stay, does not always cover the full cost of building and sustaining this infrastructure. Smaller patient volumes in a home-based model can make it harder to spread fixed costs, squeezing margins that many health systems are already managing carefully in a difficult financial environment.
Staffing is a significant challenge. Hospital-at-home programs require nurses and advanced practice providers comfortable working in home settings, often with greater autonomy than a traditional floor allows. In North Carolina, as in much of the country, clinical workforce shortages have made it harder and more expensive to recruit and retain these specialized roles.
When a program cannot staff reliably and safely, closing it is the responsible choice — even if the federal waiver remains intact and the clinical model is sound.
Patients in the Piedmont region and beyond who were receiving or expected to receive care through Cone Health's hospital-at-home program will need to transition to traditional inpatient care for acute illnesses, or explore whether other nearby health systems in North Carolina offer comparable programs.
This is a real disruption. Older adults and people managing multiple chronic conditions often find hospital-at-home preferable — familiar surroundings can support recovery, reduce the risk of hospital-acquired infections, and make care less isolating. Losing access to that option matters as much for quality of life as for clinical outcomes.
Hospital-at-home program availability in North Carolina varies significantly by region and health system. Larger academic medical centers and integrated health networks in urban areas like Charlotte, Raleigh-Durham, and the Research Triangle have been more likely to participate in the CMS waiver program than smaller community hospitals or rural systems across the state.
If you are looking for a hospital-at-home option in NC, the most reliable approach is to contact your primary care provider or specialist and ask directly whether your hospital or health system participates in the CMS Acute Hospital Care at Home initiative. You can also visit the CMS website, which publishes a list of approved participating hospitals by state.
Rural North Carolinians face a particular challenge. Hospital-at-home programs require in-person visits and logistics that are harder to sustain over long distances in areas like the mountains and coastal plains, which means rural patients are less likely to have access even where a waiver technically permits it.
Eligibility depends on both federal criteria and individual health system protocols. Medicare's waiver requires patients to meet the same criteria for inpatient admission they would in a traditional hospital—meaning the condition must be acute and require active medical management.
Not every Medicare beneficiary who could benefit will qualify. Health systems set their own clinical inclusion and exclusion criteria on top of the federal floor. Common considerations include the patient's home environment (is it safe and set up for monitoring equipment?), caregiver availability, proximity to the hospital for emergency response, and clinical stability within a defined range.
Patients on Medicare Advantage in North Carolina must also meet their plan's prior authorization and medical necessity requirements, which can differ from Original Medicare's standards.
Hospital-at-home is one piece of a larger mosaic of health coverage options for Medicare beneficiaries in North Carolina. Understanding how it fits into your overall health plan matters, especially as programs change.
If you have Original Medicare plus a Medicare Supplement plan, your Medigap policy would generally cover the same cost-sharing for a hospital-at-home stay as for a traditional inpatient admission—subject to the terms of your specific plan. This is one area where having a Medicare Supplement policy can provide meaningful financial protection if you are admitted under the waiver program.
Medicare Advantage enrollees should review their Evidence of Coverage or call their plan directly to confirm whether hospital-at-home care is covered. Because Medicare Advantage plans contract separately with CMS and set their own networks and benefits, your coverage is not automatic just because the federal waiver exists.
This is especially relevant during the Medicare Open Enrollment Period, which runs October 15 through December 7 each year, when you can compare plans and switch if your current plan does not meet your needs. For North Carolina residents, this is also a good time to check whether your preferred health system and plan combination offers hospital-at-home access.
Start by talking to your primary care physician or care coordinator as soon as you learn a program is ending. Ask them to document your clinical needs and preferences so any transition—whether to inpatient care or another program—is as smooth as possible.
Review your current health insurance or Medicare coverage to understand what alternatives are covered. If you rely on hospital-at-home as part of your care plan for a chronic condition, work with your care team to update that plan proactively, not reactively.
If you are shopping for health coverage in North Carolina — whether Medicare, an ACA Marketplace plan, or other health insurance North Carolinians can access — consider asking prospective plans whether they cover or support hospital-at-home services. As these programs expand and contract across the state, health coverage decisions will increasingly hinge on these kinds of questions.
The honest answer is uncertain. Federal policy clearly supports the model — the waiver extension through 2030 signals that CMS believes hospital-at-home has a legitimate role in the Medicare ecosystem. But operational economics are forcing individual health systems to make difficult choices, and Cone Health's exit shows that a waiver alone does not guarantee a sustainable program.
Nationally, some large health systems and hospital networks are aggressively expanding hospital-at-home, while others are pulling back. In North Carolina, the trajectory will depend on workforce availability, reimbursement adequacy, and whether CMS moves toward a permanent payment structure rather than a waiver before 2030.
North Carolinians who value this type of care should stay engaged with their health plans, advocate with their providers, and monitor developments as the post-waiver policy landscape takes shape.
This article is for general information and is not insurance or medical advice. Consult a licensed agent.