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Rural Health Information Hub

Rural Home Health Services

Access to home health services is important for people with chronic conditions or disabilities, and those who need short-term nursing and/or rehabilitation services after being discharged from the hospital. Many people depend on home health services to retain a degree of independence, to age safely in place, to avoid hospitalization, and to delay a move to a nursing home. This type of care is less costly than hospitalization or residential post-acute care, improves recovery and well-being, and eliminates the need to travel for appropriate services. However, rural populations are at risk of having inadequate access to home health services.

Frequently Asked Questions

What is included in home health services and what is the difference between home health services and home care services?

Home health services involve skilled care, and must be provided by health professionals, such as registered nurses (RNs), occupational or physical therapists, and speech-language pathologists. They can be prescribed following:

  • An inpatient hospitalization, or a stay at a rehabilitation center or a skilled nursing facility when continued care at home is needed
  • A medication change, so that a health professional can check for possible side effects and make sure the medicine is effective
  • A decline in health or functional status, necessitating rehabilitation services to restore prior function or acquire different skills and coping mechanisms

Additionally, home health services can be used to maintain the patient's condition, prevent or slow deterioration of the condition, or improve the condition. Unlike skilled nursing facilities, a patient does not need to be hospitalized prior to receiving home health services.

Home health services can include:

  • Skilled nursing care, furnished by, or under supervision of, an RN to monitor health status, administer injections or other forms of medication, conduct medical tests, or provide wound care
  • Rehabilitation services including physical, speech-language, and occupational therapy to optimize physical and cognitive functioning and performance of daily living activities
  • Provision of medical supplies (other than drugs) and medical equipment
  • Medical social services
  • Limited home health aide services for routine health-related tasks that do not require the skills of a nurse or therapist, as well as for assistance with activities of daily living

Home care services, however, are not medical in nature and are provided by home care aides who usually do not have medical training. Medicare does not reimburse for these services except when provided in conjunction with skilled nursing or therapy. Home care aides offer help with activities of daily living, such as:

  • Dressing, grooming, and bathing
  • House cleaning
  • Grocery shopping and meal preparation
  • Transportation
  • Help with bill paying
  • Medication reminders

It is important for people to have access to home health services, both as a post-acute care option and for longer-term treatment. With this type of medical care, they may be able to delay hospitalization, keep costs down, and remain in their homes as long as possible.

To what extent are home health services available in rural communities?

The Medicare Payment Advisory Commission's March 2026 chapter on home health services states that almost all Medicare beneficiaries live in a county with at least one home health agency, 97% of beneficiaries live in a ZIP code served by two or more home health agencies, and 86% live in a ZIP code served by five or more home health agencies. The U.S. Department of Agriculture reports that the number of home health agencies grew 36% between 2010 and 2023. However, it is important to consider nuances that suggest disparities in access still exist. A February 2022 brief, Quality of Home Health Agencies Serving Rural Medicare Beneficiaries, notes that 22% of home health agencies located in urban areas had a patient population of at least 10% rural beneficiaries. Additionally, 2020 and 2025 reports from the WWAMI Rural Health Research Center on rural Medicare fee-for-service beneficiaries and Medicare Advantage (MA) beneficiaries found that both utilize home healthcare less as rurality increases. The 2025 report also found that underutilization of specific home health services by rural beneficiaries may be compounded for MA beneficiaries, especially those with MA HMO plans.

Rural Health Clinics (RHCs) can be certified to provide home health services if there is no functioning home health agency in their service area. According to the Medicare Learning Network's Information for Rural Health Clinics, RHCs can supply visiting nurse services to homebound patients in areas where CMS has certified a shortage of home health agencies. Medicare.gov's Care Compare tool allows users to find and compare home health agencies in their area in terms of services offered and quality of care compared to national and state averages.

Who can order skilled home health services for Medicare beneficiaries and what is required of them?

Home health services may be ordered by a physician or an allowed non-physician practitioner including nurse practitioner, clinical nurse specialist, or physician assistant. The certifying physician or non-physician practitioner must have a face-to-face encounter with the patient related to the reason the patient needs home care within 90 days before the start of care or within 30 days after the start of care. The face-to-face encounter may be performed via telehealth if the patient is at a qualified originating site. The home health agency, working with the patient's certifying provider, must then create an individualized plan of care and review it with the physician or allowed non-physician practitioner no less frequently than every 60 days. According to the Medicare Conditions of Participation, the plan should include:

  • All pertinent diagnoses
  • Patient's mental, psychosocial, and cognitive status
  • Services, supplies, and equipment required for treatment
  • Frequency and duration of home visits
  • Prognosis and potential for rehabilitation
  • Functional limitations and permitted activities
  • Prescribed medicines and treatments, and nutritional needs
  • Recommended safety measures, to avoid injury
  • Measurable outcomes and goals
  • Any additional orders the provider wishes to include

For more information, visit Medicare's home health services webpage.

Who qualifies for Medicaid and Medicare reimbursement of rural home health services?

Home health services are considered a mandatory benefit for states to provide under the Medicaid program. However, coverage and eligibility for home health services vary by state and type of Medicaid coverage.

Medicare covers the cost of home health services for homebound beneficiaries who need intermittent, short-term, episodic skilled care, provided by a Medicare-certified home health agency or visiting nurse service. The term homebound does not refer to people who can literally never leave their homes. Instead, it signifies people who are unable to leave home without assistance or great effort, or who have a condition that would preclude them from safely leaving home alone. Patients who leave their homes for medical appointments may still be considered homebound.

CMS implemented regulations in 2018 intended to improve the quality of services and strengthen the rights of home health patients and their caregivers. As a result, home health agencies must take into consideration whether informal caregivers are willing, able, and available. Patients can also select personal representatives who can aid in making decisions about the patient's care, even if that person does not have legal status as guardian.

Who provides rural home health services, and where can they occur?

Home health agencies are certified by Medicare and/or Medicaid, are licensed by their state, and provide skilled care. Rural home health agencies can be for-profit, nonprofit, or government-run and can be freestanding or based within a facility. The WWAMI Rural Health Research Center publication, Quality of Home Health Agencies Serving Rural Medicare Beneficiaries, reports that a significantly higher percentage of rural home health agencies are nonprofit and government-run compared to urban home health agencies.

Facility-based home health agencies may be operated by a hospital, skilled nursing facility, or other facility. According to Community Impact and Benefit Activities of Critical Access, Other Rural, and Urban Hospitals, 2022, 18.6% of Critical Access Hospitals (CAHs) and 29.2% of other rural hospitals offer home health services compared to 20.6% of urban hospitals. When including hospitals that operate home health services as part of a health system or joint venture, however, 49.6% of CAHs and 62.3% of other rural hospitals offer these services. Rural Health Clinics and Federally Qualified Health Centers can also provide visiting nurse services in Home Health Shortage Areas, as noted in Section 190.1 of the Medicare Benefit Policy Manual. In some instances, rural hospitals will operate home health agencies because it is a necessary service that is not being provided by others in the community, regardless of whether it is financially advantageous to provide the services.

Care usually takes place in the patient's home. However, if the necessary equipment is too large or cumbersome to bring to a home, care can take place in a hospital, skilled nursing facility, or rehabilitation center.

Medicare.gov's Care Compare tool provides a list of home health agencies, including contact information, type of ownership, lists of services provided, and quality ratings.

Where can rural home health agencies find additional financial support?

According to the policy brief Home is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America, many rural home health agencies must rely in part on financial support from outside sources in order to remain in operation. Some report receiving money from mill levies, county health-specific or general funds, or local foundation grants. Home health agencies affiliated with or owned by hospitals may also receive funding directly from that source.

Additional funds for home health services may be available from:

  • Community nonprofit organizations
  • Local Area Agencies on Aging
  • State-level elder affairs or aging departments
  • Federal social services block grant programs
  • The Veterans Health Administration (for veterans who are at least 50% disabled due to a service-related condition)

What are some challenges faced by rural home health agencies?

Access to Rural Home Health Services: Views from the Field outlines the following challenges rural home health agencies face:

  • Compliance with Medicare's regulations and reimbursement policies
  • Equipment procurement regulations that may be impractical in rural areas
  • High turnover rates among rural healthcare workers
  • High poverty rates, population loss, and healthcare facility closures, all of which affect home health

Home is Where the Heart Is: Insights on the Coordination and Delivery of Home Health Services in Rural America cites other barriers to providing home health services, including:

  • Insufficient reimbursement from Medicare
  • High costs of implementing and maintaining electronic health records systems
  • Limitations in insurance coverage affecting service provision
  • Different interpretations in the definition of homebound status

Home health workers in rural areas face other difficulties, such as traveling long distances on poor roads or in inclement weather. In addition, providers may experience challenges in effectively serving people from different cultures and those who may not speak the same language.

Moreover, the WWAMI Rural Health Research Center policy brief Post-acute Care Trajectories for Rural Medicare Beneficiaries: Planned versus Actual Hospital Discharges to Skilled Nursing Facilities and Home Health Agencies found that only 58.7% of rural beneficiaries with a planned discharge to home health following hospital discharge received these services, indicating challenges with care transitions.

Some communities actively foster partnerships that allow home health professionals to maximize their time and provide the highest possible level of service. The Rural Monitor article Rural Post-Acute Care: Healthcare Leaders Offer Practical Solutions to Workforce Challenges describes creative ways in which one home health agency in Maine reaches patients in remote areas who might not otherwise receive needed care.

How is telehealth used to complement traditional home health services in rural areas?

The Calendar Year 2022 Home Health Prospective Payment System final rule made permanent changes to allow the use of telehealth services in assessment visits and in limited cases when performing the 14-day supervisory visit requirement. This rule also updated the home health Conditions of Participation to permit an occupational therapist to conduct the initial home health assessment visit and complete the comprehensive assessment under certain circumstances.

The 2022 Office of Inspector General (OIG) report Home Health Agencies Used Multiple Strategies To Respond to the COVID-19 Pandemic, Although Some Challenges Persist evaluated telehealth use by home health agencies during the COVID-19 pandemic. Challenges included:

  • Lack of direct reimbursement and the high cost of providing telehealth services
  • Insufficient internet access for patients
  • Physical contact required for most home healthcare

Insufficient internet access was noted as a particular concern for rural patients and home health agencies. The 2022 OIG report states that 43% of home health agencies that used telehealth during the pandemic reported they did not anticipate using it when the pandemic ended. This is reflected in the Medicare Payment Advisory Commission's March 2026 chapter on home health services which found that in 2024 less than 1% of all home health visits were telehealth visits. Transforming Care: The Impact of COVID-19 on Telehealth Adoption in U.S. Home Health Care Agencies notes that current Medicare reimbursement policy means telehealth may only supplement in-person care. Telehealth visits can fulfill the Medicare face-to-face requirement, as long as they originate at an approved site. COVID-19 public health emergency waivers allowing the patient's home as the originating site end December 31, 2027.

Data reporting is required for Medicare home health claims. More information is available in the MLN Matters brief Telehealth Home Health Services: New G Codes.

Last Updated: 7/21/2026
Last Reviewed: 7/23/2026