GAO-02-782R Medicare Home Health Utilization by State 

United States General Accounting Office 

Washington, DC 20548 

May 23, 2002 

The Honorable Henry A. Waxman 

Ranking Minority Member 

Committee on Government Reform 

House of Representatives 

Subject: Medicare: Utilization of Home Health Care by State 

Dear Mr. Waxman: 

This letter responds to your request for information on the variation in Medicare home health 

use across states. Using home health claims for the first 6 months of 2001 from the Centers 

for Medicare and Medicaid Services (CMS), we compiled statistics on home health users, 

home health visits, home health episodes, and the percentage of home health users with 

multiple episodes for each state. This information is included in enclosure I. A home health 

episode, the basis for Medicare payment under the prospective payment system, is up to a 60-

day period of care during which any number of visits may be provided. We performed our 

work in May of 2002, in accordance with generally accepted government auditing standards. 

(See enclosure II for a description of our scope and methodology.) 

As arranged with your office, unless you release its contents earlier, we plan no further 

distribution of this letter until 30 days after its issuance date. At that time, we will send 

copies to interested parties. This letter will also be available at no charge on GAO’s home 

page at http://www.gao.gov. If you or your staff have any questions regarding this letter, 

please contact me at (202) 512-7119 or James E. Mathews at (202) 512-9427. 

Sincerely yours, 

Laura A. Dummit 

Director, Health Care – Medicare Payment Issues 

Enclosures – 2 
Enclosure I Enclosure I 

2 GAO-02-782R Medicare Home Health Utilization by State 

Medicare Home Health Utilization, January-June 2001

Table 1: Medicare Home Health Users, by State

State 

Users per 1,000 

beneficiariesa,b Visits per usera Visits per episode

Alabama 39 30 20.15

Alaska 20 17 13.98

Arizona 22 18 15.02

Arkansas 35 28 19.02

California 38 22 16.67

Colorado 33 23 17.87

Connecticut 46 29 22.25

Delaware 34 24 18.98

District of Columbia 30 23 18.70

Florida 44 26 20.27

Georgia 34 28 19.84

Hawaii 16 17 14.48

Idaho 30 21 16.21

Illinois 38 21 15.95

Indiana 28 24 18.22

Iowa 24 21 16.98

Kansas 25 23 17.87

Kentucky 40 30 19.65

Louisiana 61 42 23.06

Maine 45 25 18.28

Maryland 32 19 15.64

Massachusetts 57 28 20.02

Michigan 45 23 17.83

Minnesota 17 19 15.86

Mississippi 51 33 20.36

Missouri 40 22 16.15

Montana 29 22 16.58

Nebraska 27 20 15.67

Nevada 27 23 17.91

New Hampshire 43 25 18.61

New Jersey 38 22 17.67

New Mexico 30 23 16.41

New York 37 27 21.09

North Carolina 38 22 16.04

North Dakota 30 20 16.17

Ohio 33 22 17.24

Oklahoma 47 37 22.73

Oregon 30 16 12.02

Pennsylvania 48 21 16.10

Rhode Island 56 22 16.99

South Carolina 37 22 16.16

South Dakota 23 18 14.02

Tennessee 43 31 20.81

Texas 39 34 22.51
Enclosure I Enclosure I 

3 GAO-02-782R Medicare Home Health Utilization by State 

State 

Users per 1,000 

beneficiariesa,b Visits per usera

 Visits per episode

Utah 34 39 28.44

Vermont 57 25 17.08

Virginia 34 24 17.47

Washington 27 16 13.09

West Virginia 29 22 15.46

Wisconsin 23 21 16.14

Wyoming 25 24 18.77

Nationwide 38 25 18.65

a

Figures reflect home health use during the first 6 months of 2001. They cannot be doubled 

to estimate home health use for the entire year. Doubling the 6-month figures would 

overestimate the number of users and visits. 

b

Figures reflect users per 1,000 Medicare fee-for-service (FFS) beneficiaries. We use only 

Medicare FFS enrollees because CMS data on service use exclude those enrolled in managed 

care plans and because episode payments only apply to those receiving home health care 

under fee-for-service. 

Source: GAO analysis of CMS’ home health claims (January-June 2001).
Enclosure I Enclosure I 

4 GAO-02-782R Medicare Home Health Utilization by State 

Table 2: Percentage of Medicare Home Health Users with Multiple Episodes, by State

State 

Home health users with 

only 1 episode 

Home health users with 2 

or more episodes

Alabama 53 47

Alaska 75 25

Arizona 75 25

Arkansas 56 44

California 67 33

Colorado 69 31

Connecticut 64 36

Delaware 72 28

District of Columbia 75 25

Florida 71 29

Georgia 59 41

Hawaii 76 24

Idaho 68 32

Illinois 66 34

Indiana 66 34

Iowa 72 28

Kansas 68 32

Kentucky 53 47

Louisiana 34 66

Maine 61 39

Maryland 76 24

Massachusetts 56 44

Michigan 68 32

Minnesota 76 24

Mississippi 44 56

Missouri 65 35

Montana 66 34

Nebraska 69 31

Nevada 71 29

New Hampshire 61 39

New Jersey 69 31

New Mexico 61 39

New York 69 31

North Carolina 63 37

North Dakota 72 28

Ohio 68 32

Oklahoma 45 55

Oregon 69 31

Pennsylvania 67 33

Rhode Island 66 34

South Carolina 62 38

South Dakota 72 28

Tennessee 52 48

Texas 52 48

Utah 62 38

Vermont 46 54
Enclosure I Enclosure I 

5 GAO-02-782R Medicare Home Health Utilization by State 

State 

Home health users with 

only 1 episode 

Home health users with 2 

or more episodes

Virginia 64 36

Washington 72 28

West Virginia 60 40

Wisconsin 70 30

Wyoming 69 31

Nationwide 63 37

Note: Home health users include all FFS beneficiaries who had an episode ending during the 

first 3 months of 2001. Those with two or more episodes had at least one additional episode 

during the first 6 months of 2001. 

Source: GAO analysis of CMS’ home health claims (January-June 2001). 
Enclosure II Enclosure II 

6 GAO-02-782R Medicare Home Health Utilization by State 

Scope and Methodology

We used data from Medicare provider, claims, and beneficiary files for calendar year 2001. 

We examined data on Medicare fee for service beneficiaries only. To count the number of 

home health users, the average number of visits per user, the number of episodes, and the 

average number of visits per episode, we selected Medicare claims for all episodes ending on 

January 1, 2001 through June 30, 2001 from the home health Standard Analytic File for 2001 

that were available as of January 24, 2002. We included as episodes those periods of care 

that comprised four or fewer visits, for which the home health agency received a low 

utilization payment adjustment. To calculate the share of home health users with multiple 

episodes, we used claims data to identify all beneficiaries who had an episode that ended in 

the first 3 months of the year and then determined whether they received any additional 

episodes of care during the first 6 months of 2001. Our file of 1.76 million episodes does not 

include any claims for the first 6 months of 2001 submitted after January 24, 2002. 

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