With Access To Care In Question, Number of Medicare-Certified Home Health Agencies Continues To Fall

The number of Medicare-certified home health agencies in the United States continues to dwindle, the latest data from the Medicare Payment Advisory Commission (MedPAC) reveals.

While not a dramatic drop, the decrease in the home health provider ranks is important considering pending cuts from the U.S. Centers for Medicare & Medicaid Services (CMS). Advocates fear further reimbursement setbacks could cause some agencies to close, which could accelerate industry downsizing when paired with the already evident trend.

“The cuts proposed by CMS in the CY 2024 HH PPS Proposed Rule must not be finalized,” the National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (PQHH) wrote in a joint letter shared with Home Health Care News. “Doing so risks irreparable fracturing of the foundation of skilled home health care in America and the erosion of seniors’ ability to receive care in their home.”


It wasn’t too long ago when there were over 12,000 home health providers in the U.S. By 2017, however, that number had fallen to 11,962, according to MedPAC, which released its annual data book on Monday.

By 2021, the number of Medicare-certified home health providers in operation decreased to 11,474. Last year, there were just 11,353 agencies in business.

“The number of home health agencies (HHAs) began to decline after 2013 following several years of substantial growth,” MedPAC noted in its data book. “The decline in agencies was concentrated in Texas and Florida, two states that saw considerable growth after the implementation of the home health prospective payment system in October 2000.”


Overall, the number of home health providers decreased more than 5% from 2017 to 2022.

Although that dip isn’t astronomical, it is compounded by several factors, including America’s rapidly aging population and the health care system’s shift toward home-based care, reflected in hospital-at-home programs and skilled nursing facility (SNF) alternatives.

Largely due to capacity constraints, home health operators have had to turn away an all-time high number of referrals, too.

“Together, these trends indicate that patients referred to HHAs are now less able to receive HHA care,” NAHC and PQHH wrote in their letter. “Importantly, these patients who are not taken into the care of an HHA do not simply disappear. Rather, they often are instead directed to institutional settings that cost far more and are typically a nonpreferred care setting.”

From 2017 to 2022, the number of SNFs deceased by less than 3%, according to MedPAC.

Generally, the decrease in the number of home health agencies comes as post-acute spending also falls. Fee-for-service home health spending, in particular, has decreased from $17.9 billion in 2017 to $16.9 billion in 2021, the commission reported.

“With the exception of a slight uptick in 2020, aggregate fee-for-service spending on all post-acute care sectors combined had been declining in recent years,” MedPAC explained in its data book. “In part, the decline is due to expanded enrollment in Medicare Advantage.”

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