Exploring Rural and Urban Medicare Beneficiaries' Use of Home Health Services

Home health agencies (HHAs) provide essential skilled nursing and therapeutic services to patients who manage chronic illnesses or are recovering from hospital stays. These agencies operate under state licensure regulations that define their geographic service areas and may be certified to provide Medicare home health services upon completing the Medicare application process. The Medicare Payment Advisory Commission (MedPAC) reported that access to home health care was adequate in 2021, with over 98% of Medicare fee-for-service beneficiaries residing in a ZIP code served by at least two HHAs. However, there is limited understanding of how well HHA service areas align geographically and to what extent rural Medicare beneficiaries use these services. Anecdotal evidence suggests that HHAs tend to concentrate services in high-demand areas where agency staff are located, often leaving some regions underserved, particularly in rural areas that require extensive travel time, known as "windshield time."

This project will address the following questions:

• What is the distribution of HHAs across various zip codes and counties stratified by rural and urban areas?
• To what extent do Medicare-registered HHA service areas align with actual service provision?
• Do home health service utilization patterns differ between rural and urban Medicare fee-for-service and Medicare Advantage beneficiaries?