Man in wheelchair talking with caregiver

The number of Medicare Advantage plans offering in-home supportive services (IHSS) in 2024 shrunk to its lowest number since 2021, despite the popularity of these supplemental benefits, according to healthcare research firm ATI Advisory.

“In-home support services are down pretty significantly,” Bill Winfrey, a director at research firm ATI Advisory’s Medicare innovation team, told McKnight’s Home Care Daily Pulse. “It dropped down between seven and eight percentage points from last year to this year. So it’s a pretty significant drop in one particular benefit that previously had been very popular and offered pretty commonly across plans.”

The Centers for Medicare & Medicaid Services released its most recent batch of supplemental benefit data on Oct. 2, according to ATI Advisory. The number of MA plans offering IHSS in 2024 has decreased to 721, down from the record high of 1,091 in the previous year.

A declining number of MA plans offering IHSS doesn’t necessarily mean that 2023 was a high-water mark, he said. MA plans are constantly experimenting with their “menu” of supplemental benefits, resulting in fluctuations each year. Other supplemental benefits have been on the rise. The number of plans offering caregiver supports grew from 293 to 350 going into next year, and home-based palliative care has steadily increased from 61 plans in 2020 to 195 plans in 2024.

The reasons why IHSS offerings shrunk in 2024 could be varied and numerous, Winfrey noted, but there is no definitive cause for the decline. One possible explanation is that IHSS is costly, and it can present a tougher logistical puzzle than other benefits like transportation or meal delivery. Lacking data as to the quality and efficacy of IHSS providers can also make it a tougher sell.

Winfrey noted the benefit is relatively expensive  to offer and challenging to deliver. “If you’re thinking from the plan perspective and you’re trying to figure out which benefits to offer, and you have a reasonably expensive, relatively complex benefit to offer, that introduces some questions on behalf of the plan in terms of whether that might be a benefit they want to offer,” he said.

Still, IHSS has been the most popular benefit among MA beneficiaries nearly every year since 2020. Only in 2022 was it knocked off the top spot, earning second place to the food and produce benefit. 

There might be other factors affecting the number of IHSS offerings, ATI Advisory’s experts noted. Papa Inc. was a popular provider of IHSS through many MA plans, but concerns about potential abuse raised in July may have contributed to the benefit’s decline.

CMS’ supplemental benefit data also revealed that plans are also more commonly using the Value-Based Insurance Design (VBID) model to offer these benefits, Winfrey said. As CMS looks to shift into Phase III of VBID in 2025, supplemental benefit offerings may also be altered. Under this new phase, plans will be required to offer benefits addressing at least two of three areas: food, housing and transportation. Some plans are already adjusting their benefit offerings in anticipation of this shift.

“We saw the biggest spikes in general supports for living — which is used to address housing — food and produce and transportation,” Winfrey said. “Plans seeing this change coming in 2025 seem to already be getting ahead of the curve and starting to offer these benefits,” he added