Home Health Quality Ratings: Star Distribution Across 12K Agencies
CMS quality star rating distribution for 12,392 Medicare-certified home health agencies — performance tiers, ownership mix, and the 35.8% of agencies below the minimum claim threshold. Star ratings are CMS-published; Fonteum does not rate, inspect, verify, endorse, or guarantee any agency.
Key findings
- •12,392 Medicare-certified home health agencies are tracked in the CMS Care Compare database as of the 2026-05-25 snapshot. Star ratings are CMS-published quality-of-patient-care scores; Fonteum does not independently rate, inspect, verify, endorse, or guarantee any agency.
- •Only 7,961 of 12,392 agencies (64.2%) carry a CMS quality star rating. The remaining 4,431 (35.8%) are typically new entrants or low-volume providers that do not meet CMS's minimum claim volume threshold — a substantially higher unrated share than CMS nursing-home (0.9%) or dialysis (6.4%) datasets.
- •Among 7,961 rated agencies, the distribution clusters around 3.0–3.5 stars (the industry midpoint). Only 5.75% achieve 5-star status while 19.2% score ≤ 2.0 stars, forming a visible low-performance tail.
- •High performers (≥ 4.0 stars) represent 35.0% of rated agencies (2,786 agencies). The modal band is 3.0 stars at 16.92%, with a slight bell curve skewed toward the lower end.
- •72.93% of home health agencies operate under Proprietary (for-profit) ownership — consistent with the post-ACA expansion of private HH operators. Non-profit agencies represent 8.62%; Government-owned, 2.02%; Unknown ownership, 16.44%.
At a glance
12,392
Medicare-certified home health agencies
Total agencies in the CMS Care Compare Home Health database as of the 2026-05-25 snapshot. Source: cms_care_compare_hh (17th federal source family).
35.8%
Agencies below the rating threshold
4,431 of 12,392 agencies have no CMS star rating. Typically new entrants or low-volume providers that do not meet CMS minimum claim volume requirements for rating eligibility.
5.75%
5-star agencies among rated
458 of 7,961 rated agencies achieve a 5.0-star quality-of-patient-care rating. High performers (≥ 4.0 stars) represent 35.0% of all rated agencies (2,786 agencies).
19.2%
Low performers (≤ 2.0 stars)
1,527 of 7,961 rated agencies score 2.0 stars or below: 1.5-star (593 agencies) and 1.0-star (156 agencies) clusters anchor the low-performance tail.
3.0–3.5★
Modal star band
3.0-star (1,347 agencies, 16.92%) and 3.5-star (1,338 agencies, 16.81%) are the two most common bands — the industry midpoint, slight bell curve with leftward skew.
72.9%
Proprietary (for-profit) ownership
8,962 of 12,277 agencies with known ownership type are Proprietary. Non-profit: 8.62% (1,059). Government: 2.02% (248). Unknown: 16.44% (2,018 of full 12,277).
Overview
The CMS Care Compare Home Health database tracks 12,392 Medicare-certified home health agencies across the United States. This study describes the distribution of CMS quality-of-patient-care star ratings as of the 2026-05-25 database snapshot.
What these ratings are: CMS computes quality star ratings from Medicare claims data across a set of quality measures — process measures (flu/pneumonia vaccines, initiating care) and outcome measures (improvement in walking, improvement in bathing, etc.). Star ratings reflect CMS's evaluation, not Fonteum's. Fonteum surfaces these ratings as published; we do not modify, supplement, or independently confirm them.
What these ratings are not: A comprehensive ranking of all home health agencies. 35.8% of agencies in the database carry no star rating — primarily because they are new entrants or have not yet reached the minimum claim volume CMS requires for rating eligibility. The unrated population is disproportionately small and/or new, not necessarily low-quality.
Star rating distribution
Among 7,961 rated agencies, the distribution clusters around the 3.0–3.5-star midpoint with visible performance tails at both ends.
| Star Rating | Agencies | % of Rated |
| 5.0 ★ | 458 | 5.75% |
| 4.5 ★ | 1,041 | 13.08% |
| 4.0 ★ | 1,287 | 16.17% |
| 3.5 ★ | 1,338 | 16.81% |
| 3.0 ★ | 1,347 | 16.92% |
| 2.5 ★ | 963 | 12.10% |
| 2.0 ★ | 778 | 9.77% |
| 1.5 ★ | 593 | 7.45% |
| 1.0 ★ | 156 | 1.96% |
High performers (≥ 4.0 stars): 2,786 agencies — 35.0% of rated, 22.5% of all 12,392 agencies.
Low performers (≤ 2.0 stars): 1,527 agencies — 19.2% of rated, 12.3% of all agencies.
The modal band is 3.0 stars (16.92%), with 3.5 stars close behind (16.81%). The curve is broadly bell-shaped with a leftward skew: the low-performance tail (1.5–2.0) has more agencies than the high-performance tail (4.5–5.0).
The unrated population
4,431 agencies (35.8%) carry no CMS quality star rating. This is a substantially higher unrated share than other CMS Care Compare facility types:
- Home Health: 35.8% unrated - Dialysis: ~6.4% unrated (comparative estimate) - Nursing Home: ~0.9% unrated (comparative estimate)
CMS's minimum claim threshold for home health rating eligibility requires an agency to have at least 20 qualifying episodes over a given measurement period. New entrants, small-volume providers, and agencies serving narrow geographic catchments are most likely to fall below this threshold.
The unrated population is not randomly distributed. Proprietary ownership is overrepresented among unrated agencies relative to the rated population — consistent with the pattern that new private-sector entrants take longer to accumulate the claim volume needed for a CMS rating.
Ownership mix
Home health is overwhelmingly for-profit. Among 12,392 agencies:
| Ownership Type | Agencies | % of Total |
| Proprietary (for-profit) | 9,033 | 72.93% |
| Non-profit | 1,068 | 8.62% |
| Government | 250 | 2.02% |
| Unknown | 2,041 | 16.44% |
The 72.93% Proprietary share is consistent with the post-ACA expansion of private home health operators. The Affordable Care Act expanded Medicare home health benefits and attracted significant private investment, particularly in high-density metropolitan markets.
Services offered: The majority of agencies offer nursing care, physical therapy, and home health aide services. Occupational therapy, speech pathology, and medical social services are offered by a smaller subset, reflecting staffing and licensure constraints rather than market demand.
Methodology
Data sourced from the CMS Care Compare Home Health Care Agencies database (PDC dataset 6jpm-sxkc), ingested into the cms_care_compare_hh table (17th federal source family, methodology version cms-care-compare-hh/v1). Snapshot date: 2026-05-25. Star ratings are CMS-published quality-of-patient-care scores computed by CMS from Medicare claims data; Fonteum does not independently compute, modify, or confirm these ratings. Agencies with NULL quality_star_rating are classified as unrated per CMS methodology — typically new entrants or agencies below the minimum claim volume threshold. Ownership type percentages derived from the type_of_ownership column; agencies with NULL ownership are classified as Unknown. All counts are from direct query on the cms_care_compare_hh table as of 2026-05-25.
Full methodology documentation: /methodology#cms-care-compare-hh