In 2008, Barack Obama and Joe Biden promised to make it easier for severely disabled Medicare patients to keep their home-health benefits.

The law required that beneficiaries be "confined to the home" to be eligible for care from home health aides or skilled health services.

While there were exceptions, such as for doctor visits or special events or trips outside the house of "infrequent or of relatively short duration," some home health agencies interpreted the rules very narrowly — and patients would lose their coverage for leaving the house.

Obama and Biden promised to "amend the Medicare 'homebound' rule, which requires severely disabled recipients to stay in their homes to retain benefits, so that they have the freedom to leave their homes without fear of having their home-health benefits taken away."

That campaign statement exaggerated the severity of the law — Medicare beneficiaries already had "the freedom to leave their homes" as long as it was infrequent or brief — but did reflect the reality of how the law was often applied.

Medicare contractors "sometimes try to require that those receiving home health services will be discharged and found not to need skilled care if they leave home for any reason other than a limited number of visits for a few specific purposes, such as going to a doctor," the Kaiser Family Foundation reported in 2005.

It didn"t seem to matter that this interpretation was "at odds with the actual language of the law, which allows individuals to leave home for any reason of their choice so long as it is for an 'infrequent or of relatively short duration,"" the foundation reported.

In 2002, the Bush administration told Medicare providers to allow patients to attend special occasions such as family reunions, graduations or funerals without risking their benefits. Such trips had led home health agencies and Medicare payment contractors in some cases to cut off patients. Health and Human Services updated the Medicare manual to clarify.

Obama and Biden promised to change the law "to remove arbitrary measures of 'acceptable" time away from home and further ensure that individuals do not have benefits removed unfairly."

But neither the law nor the Medicare manual has been updated, and qualifying for benefits is still a significant issue, said Brad Plebani, deputy director of the nonprofit Center for Medicare Advocacy. Medicare contractors still pounce on trips outside the home to terminate or refuse benefits even when a patient otherwise has a hard time getting around.

"Our experience is that they are construing it very narrowly," Plebani said. "... It's not surprising some people would think they could never leave home."

We gave the Centers for Medicare & Medicaid Services 10 days to respond, but it did not provide additional information.

As far as we can tell, there"s been no relevant change to the Medicare statute or manual since 2003. We rate this Promise Broken.