For a growing number of patients, "being admitted to the hospital" no longer means staying in a hospital bed. Under Medicare's Acute Hospital Care at Home initiative, approved hospitals can treat certain patients who need inpatient-level care in their own homes, with nurses visiting in person, physicians rounding daily, and the hospital remaining responsible for their care.

Since late 2024, the program had lived on short-term extensions. That changed in February 2026, when Congress extended it through September 30, 2030. With the program on firmer footing, we expect more patients and families in Southern California to encounter it. This guide explains how hospital at home works, what the extension means, and where medical transportation fits in.

What Is Hospital at Home?

The Centers for Medicare & Medicaid Services (CMS) launched the Acute Hospital Care at Home initiative in November 2020. CMS describes it as allowing certain Medicare-certified hospitals to treat patients with inpatient-level care at home. It is not the same as home health: CMS says it is for patients who require acute inpatient admission and at least daily rounding by a physician and a medical team monitoring their care.

A few basics from CMS:

According to CMS's 2024 report to Congress on the program, the most common types of care were respiratory (36%), circulatory (16%), renal (16%) and infectious diseases (12%). The three most common diagnosis groups were heart failure, respiratory infections and sepsis. Patients ranged in age from 21 to 107, with an average age of 77.

What the Extension to 2030 Changes

Division J, section 6210 of the Consolidated Appropriations Act, 2026 (Public Law 119-75), approved February 3, 2026, moved the program's end date from January 30, 2026 to September 30, 2030. CMS confirmed the extension in a March 17, 2026 fact sheet.

That stability matters. Before this law, the program was extended in short increments, and the authority expired after September 30, 2025, during the federal government shutdown; the New Jersey Department of Health, relaying CMS's instructions, told hospitals that inpatients had to be discharged or returned to the hospital on that date. Congress restored the program in a funding law signed November 12, 2025. In our view, an extension that runs to 2030 gives hospitals more reason to invest in staff, equipment and the outside partners these programs depend on.

The same law also requires the Department of Health and Human Services, which oversees CMS, to complete a new study by September 30, 2029. Among other things, that study must look at transfers between the hospital and the home in both directions, including the timing, frequency and causes of transfers from the home back to the hospital.

How Big Is the Program?

As of October 19, 2026, CMS's approved list showed 358 approved CMS Certification Numbers (CCNs) across 134 health systems in 37 states. CMS reported in December 2024 that more than 31,000 patients had been served in home settings through October 2024.

In Los Angeles, Orange and Kern Counties, CMS's approved list includes:

Being on CMS's list means a hospital has an approved waiver; it does not necessarily mean that hospital is admitting patients to a home program today. If you are interested, ask the hospital's care team directly. West Coast Ambulance is not affiliated with these hospitals or their hospital-at-home programs.

What Care Looks Like at Home

Hospitals in the program agree to safety requirements set out in CMS's waiver process. They include:

Hospitals must also provide or contract for a list of services that includes pharmacy, infusion, respiratory care including oxygen, labs and radiology, durable medical equipment, therapy, social work and care coordination, meals, and transportation. CMS is clear that the hospital remains legally responsible for the patient's care regardless of contractual arrangements.

Where Medical Transportation Fits In

Transportation is written into the program's design. Every participating hospital must provide or contract for transportation, which CMS's 2024 report describes as "Transportation between the hospital and the home in both directions." CMS's detailed waiver application, used by hospitals that have treated fewer than 25 hospital-at-home patients, asks how the hospital will transport patients between the emergency department and their homes, and back to the hospital if needed, including whether transport is provided by ambulance, non-ambulance medical transport or other means. When CMS interviewed hospitals applying for the waiver, it reviewed their process for securing the initial transport home.

In practice, there are three kinds of trips to plan for:

1. The trip home from the emergency department or hospital

Because patients enter the program from an ED or an inpatient bed, every episode starts with a move home. A patient who is still acutely ill may need a stretcher or ambulance rather than a car. In a CMS blog post, one patient treated through the program recalled being "transported home by ambulance."

2. Trips for care that cannot happen at home

CMS's detailed waiver application asks hospitals how patients will receive diagnostic studies and services that are not available in the home. Some of those may require a round trip to the hospital. CMS's program FAQ notes that a trip to the emergency department for tests that ends with the patient returning home is not counted as an "escalation" of care.

3. Escalation back to the hospital

If a patient's condition worsens, they may need to return to a traditional hospital bed. CMS tracks this as the program's "escalation rate." Urgent changes are covered by the 30-minute emergency response requirement, which can involve 911. CMS's report also noted anecdotal reports that some patients felt anxious about having to return to the hospital, and that some programs began discussing that possibility during the consent process.

For families: Hospitals in the program must provide or contract for transportation as part of the patient's care, and CMS's detailed waiver application asks hospitals how they will explain that responsibility to the patient's support person. Before the patient goes home, ask the care team who to call for each type of trip, including what happens in an emergency.

What This Means for Hospitals and Transport Partners

In our view, the extension to 2030 makes hospital at home a longer-term part of how acute care is delivered, and transportation is one of the services that has to work reliably for it to succeed. CMS's study shows why it matters: hospitals approved through the detailed pathway told CMS they would only admit patients whose homes allowed timely transport to an acute care facility, with distances in their criteria ranging from 5 to 30 miles and/or within 30 minutes of driving.

For hospitals building or growing a program, the practical questions are familiar to anyone who plans hospital discharges: Which level of transport does each patient need for the trip home? Who books non-urgent round trips for tests? How quickly can a stretcher or ambulance be scheduled? Our guide to stretcher versus wheelchair transport covers how the level of transport is matched to the patient.

How West Coast Ambulance Can Help

West Coast Ambulance provides scheduled wheelchair and stretcher transportation across Los Angeles, Orange and Kern Counties, and BLS ambulance and critical care transport in Los Angeles and Orange Counties. Our dispatch team answers 24/7/365. Hospitals and care teams can learn about setting up a facility account on our For Facilities page, and families can call 800-880-0556 or request a ride online. If the patient is currently admitted to a hospital-at-home program, coordinate transport through the hospital's care team first. For an emergency, always call 911.

Frequently Asked Questions

What is Medicare's hospital at home program?

The Acute Hospital Care at Home initiative lets CMS-approved hospitals treat certain patients who need inpatient-level care in their homes. Patients are admitted from an emergency department or an inpatient bed after an initial in-person exam by the admitting physician or advanced practice provider, receive at least daily physician or advanced practice provider rounding and at least two in-person visits a day from a nurse or mobile integrated health paramedic, and remain under the hospital's responsibility.

How long has the hospital at home waiver been extended?

Section 6210 of the Consolidated Appropriations Act, 2026, approved February 3, 2026, extended the Acute Hospital Care at Home initiative through September 30, 2030. The previous extension had run through January 30, 2026.

Which hospitals in Los Angeles, Orange and Kern Counties are approved for hospital at home?

As of October 19, 2026, CMS's approved list included Adventist Health Glendale, Adventist Health White Memorial, Cedars-Sinai and Keck Hospital of USC in Los Angeles County; UCI Health and Hoag Hospital Newport Beach in Orange County; and Adventist Health Bakersfield in Kern County. Approval does not necessarily mean a hospital is currently admitting patients to a home program.

Who arranges transportation for hospital at home patients?

The hospital. CMS lists transportation among the services a participating hospital must provide or contract for, and its 2024 report describes this as transportation between the hospital and the home in both directions. CMS's detailed waiver application also asks hospitals to describe whether patients are transported by ambulance, non-ambulance medical transport or other means.

What happens if a hospital at home patient gets worse?

Participating hospitals must be able to get an appropriate emergency team to the patient's home within 30 minutes if needed, which CMS says can be provided by 911 or emergency paramedics. Patients who need a higher level of care are transferred back to the traditional hospital setting, which CMS tracks as the escalation rate.

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