A significant healthcare equity gap emerges when adult patients requiring palliative care cannot access home-based services that are readily available to children under the same insurance program. This disparity forces seriously ill adults into institutional settings when comfort care at home might be more appropriate and cost-effective. Vermont's Medicaid program exemplifies this inconsistency by covering home-based palliative care for pediatric patients while denying the same benefit to adults. Researchers conducted in-depth interviews with six Vermont clinicians and focus groups with eleven home health agency representatives to understand barriers preventing adult home-based palliative care expansion. The analysis revealed four critical obstacle categories: treatment quality concerns, staffing and referral challenges, communication barriers around palliative care definitions, and financial accessibility issues for home health agencies. Healthcare professionals identified workforce shortages and inadequate reimbursement structures as primary impediments to service delivery. Many agencies struggle to maintain specialized palliative care teams without sustainable funding models. The findings illuminate a broader national challenge where palliative care access varies dramatically by age group and geography. Unlike hospice care, which focuses on end-of-life comfort, palliative care addresses symptom management and quality of life throughout serious illness progression. This research suggests that expanding Medicaid coverage for adult home-based palliative care could reduce hospitalizations, lower healthcare costs, and improve patient outcomes. The study provides crucial groundwork for policy discussions around healthcare equity and resource allocation in an aging population increasingly requiring complex care coordination.