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Is High-Quality Home Health Care “Out of Reach” for Black Medicare Beneficiaries?

By Marie Steele-Adjognon, PhD, Inna Cintina, PhD, and Lane Koenig, PhD
January 31, 2023

Home health agencies (HHAs) are an important source for skilled nursing care, with 3.1 million traditional Medicare beneficiaries receiving such services in 2020. Two potentially important advantages of home health are: (1) patient preference for recovery at home; and (2) lower costs to beneficiaries, since there is no cost sharing for home health in Medicare. However, studies have documented lower access to high-quality HHAs for Black beneficiaries, with resulting disparities in outcomes. In a recent study, Fashaw-Walters and colleagues reported that access to high-quality HHA services was “out of reach” for Black Medicare beneficiaries and other vulnerable populations. This finding is at odds with our own research, published in a recent Commonwealth Fund Issue Brief, where we found no significant difference in access to high-quality HHAs between White and Black beneficiaries. To better understand these divergent findings and implications, we examine differences in the research designs of the two studies and then explore how these differences can lead to different conclusions.

Studies Differ in Terms of Research Design

  • Assessment of different patient populations. To qualify for home health benefits in Medicare, a beneficiary must be considered homebound and require skilled nursing or therapy […]
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