Work

Community-Entry Home Health Made Up Nearly Half Of Home Health Episodes And Spending In Traditional Medicare, 2017–21

Year: 2026

Type: article

Abstract: Medicare home health care is often characterized as a postacute care benefit, yet community-entry users-those admitted without a preceding hospitalization-account for nearly half of all spending and episodes in traditional Medicare. Using Medicare administrative data from 2017, 2019, and 2021, we analyzed differences between community-entry and postacute home health users. Community-entry beneficiaries were older; were more likely to be dually eligible; and had substantially higher rates of cognitive impairment, Alzheimer's disease, and depression compared with postacute users. Despite these clinical differences, visit patterns remained similar between groups. We documented significant state-level variation in community-entry prevalence, with changes in community-entry share that were positively associated with changes in overall home health spending. Our findings reveal a fundamental tension between policies that favor postacute care and the reality of Medicare home health use, which serves a substantial population with clinical and demographic profiles that differ from those of postacute care users.

Source: Health Affairs

DOI: 10.1377/hlthaff.2025.00318

Authors: Ilana Salant, Mark Shepard, Nicole Maestas, Timothy J. Layton, David C. Grabowski

Institutions: Harvard University, National Bureau of Economic Research, University of Virginia

Language: English

Topic: Healthcare Policy and Management

Subfield: Economics and Econometrics

Field: Economics, Econometrics and Finance

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: green

Funder: National Institutes of Health