Availability of Medicare-Certified Hospice Services in Minoritized Racial/Ethnic Group Areas


Prior research has shown rural residents and persons from minoritized racial/ethnic groups (MRGs) are less likely to receive a hospice benefit before death. Using CMS-certified hospice providers and their associated ZIP code, the ZIP codes were translated into ZIP code tabulation areas (ZCTAs) using the Uniform Data System (UDS) crosswalk. The UDS crosswalk is a mapping project funded by the Health Resources and Services Administration.

The total number of hospices offering services in each ZCTA were tallied. The hospice counts were then grouped into four categories. CMS-certified hospice providing services are not available in 5.6% of ZCTAs and 14.2% are served by a single hospice. Alaska, North Dakota, and Wyoming had the highest proportion of in-state ZCTAs lacking any hospice service. In 2020, 2.4% of all urban ZCTAs had no service while 9.4% of all rural ZCTAs had no service. In urban ZCTAs, American Indian/Alaska Native residents (3.8%), Asian American/Pacific Islander residents (3.3%), and non-Hispanic White residents (12.1%) were more likely to lack any hospice service than the comparison group (1.5%). In rural ZCTAs, American Indian/Alaska Native (32.6%), Asian American/Pacific Islander (12.9%), non-Hispanic white (24.7%), and multiple MRG groups (23.1%) were each more likely than the comparison group to lack any hospice service (4.5%).

Rural and Minority Health Research Center
Janice Probst, Nicholas Yell, Gabriel Benavidez, Jan Eberth, Melinda Merrell