Home Health Rating Availability Across 12,392 Agencies

Key findings

• 12,392 Medicare-certified home health agencies appear in the CMS Care Compare production table released 2026-05-07. 7,961 (64.24%) have a quality star rating; 4,431 (35.76%) do not.
• All 4,431 unrated rows include a CMS footnote saying the number of patient episodes is too small to report. This is a rating-availability result, not evidence of poor quality.
• Among rated agencies, 458 (5.75%) have five stars, 2,786 (35.00%) have four stars or more, and 1,527 (19.18%) have two stars or less.
• The unrated share is 35.76% for home health, 6.42% for dialysis facilities, and 0.90% for nursing homes in the joined current-production sources.
• Proprietary agencies are 76.22% of rated agencies and 67.01% of unrated agencies. They are overrepresented among rated agencies, reversing the prior article's interpretation.

At a glance

The main finding is a rating-availability gap

The CMS Care Compare source contains 12,392 Medicare-certified home health agencies. 4,431 (35.76%) have no reported quality-of-patient-care star rating.

The source itself supplies the reason: all 4,431 unrated rows include a footnote stating that the number of patient episodes is too small to report the measure. Three of those rows also include special-needs-population wording. An absent rating therefore should not be read as a low rating or as evidence about the agency's quality.

Star distribution among rated agencies

The denominator for this table is 7,961 rated agencies.

Four stars or more: 2,786 agencies (35.00% of rated). Two stars or less: 1,527 agencies (19.18% of rated). The largest single band is 3.0 stars with 1,347 agencies (16.92%).

Home health has the widest unrated share in this comparison

The three settings use different CMS rating methods and eligibility rules. The percentages describe rating availability in the current source tables; they do not support a cross-setting quality ranking.

Ownership mix and the corrected rated/unrated split

Proprietary agencies make up 72.93% of all agencies, 76.22% of rated agencies, and 67.01% of unrated agencies. The production split shows proprietary ownership is more prevalent among rated agencies, not among unrated agencies. This is descriptive composition and does not establish that ownership determines rating availability.

Methodology

The canonical read-only SQL aggregates the full cms_care_compare_hh production table on PostgreSQL, not a paged API response. Rated means quality_star_rating is non-null; unrated means it is null. Star bands are grouped on the numeric source value. Ownership uses the four values present in production. The comparison counts come from the current dialysis table and the latest nursing-home provider-information provenance period. Source release: 2026-05-07. Production observation: 2026-07-17.

Broader documentation: home health methodology.

Limitations

• A missing CMS star rating is not a zero and is not evidence of low quality. Every unrated source row cites too few patient episodes to report the measure.
• The three care-setting comparison sources use different rating methods, reporting thresholds, and populations. Their unrated shares are not quality rankings.
• Ownership is the category published by CMS. The source uses "-" for 2,037 agencies, which this study labels Unknown.
• The source release is 2026-05-07; production was observed 2026-07-17. CMS can revise ratings, footnotes, and agency participation after that date.
• The analysis is descriptive and does not adjust for agency age, service volume, geography, patient mix, or other factors associated with rating availability.

Frequently asked questions

Why do some home health agencies have no CMS quality star rating?

Every one of the 4,431 unrated source rows includes a CMS footnote saying the number of patient episodes is too small to report. Three rows also include special-needs-population wording. A missing rating is not a zero-star rating.

Are proprietary agencies more common among rated or unrated agencies?

Proprietary agencies are 76.22% of rated agencies and 67.01% of unrated agencies in this snapshot. The production distribution therefore places them more heavily in the rated cohort.

What date does this home health study represent?

The CMS source release date is 2026-05-07. The production result was re-derived on 2026-07-17. The May 25 timestamp is the ingestion date, not the source-release date.

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