For years, families across the country have heard the same devastating message from a home health agency or insurance plan: "Your loved one has stopped improving, so Medicare will no longer cover their therapy or nursing visits." It is a statement that has denied tens of thousands of older adults the care they need — and it is almost certainly wrong.
The truth is that Medicare covers home health care for maintenance, not just improvement. This is not a gray area or a loophole. It is the law, settled by a landmark class-action lawsuit known as the Jimmo v. Sebelius settlement. In July 2026, the Center for Medicare Advocacy renewed its outreach to make sure every family knows about it — because despite being settled nearly a decade ago, the Jimmo rule remains one of the most underused protections in Medicare today.
If you have been told that your loved one's home health services are ending because they have "plateaued" or are "no longer making progress," keep reading. This information could change everything.
What Is the Jimmo Settlement?
The Jimmo settlement is the result of a 2011 class-action lawsuit filed against the U.S. Department of Health and Human Services. The plaintiffs — led by a Vermont woman named Glenda Jimmo — argued that Medicare was illegally denying coverage for skilled nursing and therapy services to beneficiaries who needed those services to maintain their condition or slow decline, rather than to improve.
Before Jimmo, many Medicare contractors, claims processors, and home health agencies operated under what became known as the "improvement standard." If a patient with Parkinson's disease, multiple sclerosis, ALS, Alzheimer's, advanced heart failure, or COPD was not showing measurable improvement in therapy, the assumption was that Medicare no longer needed to pay. This practice was never written into Medicare law, but it had become the de facto standard across much of the country.
In 2013, a federal court approved the settlement agreement, and CMS issued nationwide guidance making it clear: Medicare covers skilled care when it is needed to maintain a patient's functional status or prevent or slow decline — regardless of whether the patient is expected to improve.
Despite this clear directive, studies and surveys have shown that years later, many families, clinicians, and even some home health agencies still do not fully understand the Jimmo standard. The result is that patients who are legally entitled to care are routinely denied it.
Who Does Jimmo Protect?
Jimmo is especially important for people living with conditions that are progressive or degenerative by nature — the very conditions that most often require skilled home care over the long term.
This includes seniors living with:
For any of these conditions, the "improvement standard" creates an impossible Catch-22: you need care to keep from getting worse, but because you are not getting better, the system denies you that care. Jimmo exists specifically to break that cycle.
What Does Jimmo Actually Cover?
Under the Jimmo standard, Medicare Part A and Part B cover the same skilled services they always have — but with one critical clarification: the medical necessity of skilled care is determined by the patient's need for skilled services, not by their potential for improvement.
In practical terms, this means Medicare will cover:
**Skilled nursing** to manage, observe, and evaluate a patient's condition — even when no improvement is expected. For example, a patient with advanced Parkinson's disease may need a skilled nurse to monitor medication timing and dosage adjustments, manage falls, educate the family on safety, and prevent complications like aspiration pneumonia. Under Jimmo, that care is covered even if the patient's underlying condition continues to progress.
**Physical therapy** to maintain functional mobility. A patient with multiple sclerosis who needs a therapist to design and supervise a maintenance exercise program to preserve the ability to transfer from bed to chair, to walk short distances, or to prevent muscle contractures — that is covered under Jimmo.
**Occupational therapy** to maintain the ability to perform daily activities like feeding, dressing, bathing, and toileting. For someone with moderate dementia, an occupational therapist can develop strategies and environmental modifications that allow the patient to continue performing these tasks safely.
**Speech-language pathology** to maintain swallowing safety and communication. For a patient with ALS whose speech is declining, a speech therapist can teach compensatory strategies, introduce augmentative communication devices, and perform periodic swallowing evaluations to prevent aspiration.
The key point is that a physician must certify that the patient needs the skilled services, and the home health agency must document the care plan. The standard is the same as it has always been — except that "need for skilled care" cannot be denied simply because the patient is not expected to improve.
Why Are Families Still Being Told the Wrong Thing?
If the Jimmo settlement was approved in 2013, why are families still being told that Medicare does not cover maintenance care?
The answer is that changing a deeply embedded practice across thousands of Medicare contractors, home health agencies, and insurance plans takes time — and, frankly, the system has not fully complied. The Center for Medicare Advocacy continues to track compliance issues and reports that some Medicare Administrative Contractors (MACs) continue to issue denials based on the illegal improvement standard. Many home health agencies, uncertain about how Jimmo applies in practice, err on the side of caution and discharge patients who appear to have plateaued.
Additionally, Medicare Advantage plans — which now cover more than half of all Medicare beneficiaries — frequently apply their own internal coverage criteria that are more restrictive than traditional Medicare's. The Jimmo settlement legally applies to both traditional Medicare and Medicare Advantage, but enforcing it in court against a private insurer is far more burdensome for families than filing an appeal through the standard Medicare process.
The result is that thousands of families quietly accept denials that are illegal. They are told "your loved one no longer qualifies" and they have no reason to doubt it. They go without care, and their loved one's condition declines faster than it needed to.
What to Do If You Are Denied Care Based on the "Improvement Standard"
If your loved one has been denied continued home health services because they have "stopped improving" or "reached a plateau," here is what you should do:
**Step 1: Ask for the denial in writing.** You have the right to a written explanation of why services were denied or terminated. This document will be your evidence.
**Step 2: Cite the Jimmo settlement.** When you appeal, use the language from the Jimmo settlement explicitly. Say: "Under the Jimmo v. Sebelius settlement, Medicare covers skilled care that is needed to maintain the patient's condition or prevent or slow decline. The 'improvement standard' is not valid grounds for denying coverage."
**Step 3: Ask your doctor to write a clear order.** The single strongest piece of evidence in any Medicare home health appeal is a physician's order stating that the patient needs skilled services to maintain function, prevent decline, or manage an unstable condition. Make sure the order uses maintenance language — not improvement language.
**Step 4: Contact the home health agency's administrator.** Many denials start with a frontline staff member or mid-level manager who may not understand Jimmo. Escalate to the agency's clinical director or administrator and ask them to review the policy.
**Step 5: Use the Medicare appeals process.** If the agency still will not restart services, file a formal Medicare appeal. There are five levels of appeal, from redetermination all the way to federal court, and the vast majority of cases are resolved at the first level. You can also contact your local State Health Insurance Assistance Program (SHIP) for free, one-on-one counseling on how to appeal.
**Step 6: Contact the Center for Medicare Advocacy.** The organization that brought the Jimmo lawsuit offers free resources and guidance on its website for families facing improper denials.
The Bigger Picture: Why Jimmo Matters More Than Ever in 2026
With the population of Americans over 65 growing faster than ever, and the number of people living with chronic, progressive conditions rising in tandem, Jimmo has never been more important. The July 2026 news from the Center for Medicare Advocacy — a renewed push to educate families about the Jimmo standard — is a timely reminder that this protection exists, but only if people know about it and use it.
As CMS considers new rules for home health in CY 2027 — including proposed updates to provider enrollment and quality programs (as reported by the American Hospital Association in early July 2026) — the Jimmo standard remains a bedrock protection that no new rule can undo. Whether you are on traditional Medicare or a Medicare Advantage plan, the right to skilled care for maintenance is not negotiable. It is the law.
But a law only helps the people who know how to use it. If you or your loved one has been denied care, do not accept the first answer. Ask about Jimmo. Appeal the decision. And if you need help navigating the process, you do not have to do it alone.
You Do Not Have to Navigate This Alone
Understanding your rights under Medicare home health coverage — including the Jimmo settlement — can feel overwhelming, especially when you are already caring for a loved one with a serious health condition. But the law is on your side, and help is available.
At Home Health Plan Finders, our care advisors stay current on Medicare rules, coverage protections, and the latest appeals processes so you do not have to. Whether you have been denied care, are preparing for a loved one's transition home from the hospital, or simply want to understand what Medicare covers for a progressive condition, we are here to help with free, personalized guidance.
Visit homehealthplanfinders.com/get-quote to speak with a care advisor today. No cost, no obligation, no pressure — just honest, knowledgeable advice that puts your family's needs first.