The Centers for Medicare & Medicaid Services (CMS) Acute Hospital Care at Home (AHCaH) waiver resulted in the largest expansion of the Hospital-at-Home (HaH) to date. HaH programs allowed older adults at high risk for adverse out- comes from COVID-19 to receive high-quality acute hospital-level care at home. HaH is a com- plex care delivery model. Using a qualitative approach, we examined issues related to estab- lishing HaH programs under the CMS waiver. We found that HaH leaders were enthusiastic about advantages of HaH for patients and fami- lies. Program leaders reported concerns about the future of the CMS waiver given that its existence is tied to the COVID-19 public health emergency. Key implementation issues included building
electronic health records components for HaH and having the sufficient staff to support HaH pro- grams. The stage between planning and imple- mentation represented the largest hurdle and technical assistance should be most focused in this stage