The number of people using Medicaid home care grew faster than the number of providers serving them from 2019 to 2023, reaching 65.65 participants per billing provider, up from 59 in 2019. The finding comes from the inaugural Medicaid Home Care Chartbook, released April 27, 2026 by the Research Institute for Home Care and the National Alliance for Care at Home. Home Health Care News reported it on May 12.
Health Management Associates compiled the chartbook, mostly from 2023 federal Medicaid claims data (T-MSIS).
Who uses Medicaid home care
The researchers identified about 3.3 million people who received Medicaid-funded home care in 2023. Of those, 45% were also on Medicare and 10% were enrolled through the Affordable Care Act expansion. About 48% got at least some services through a managed care organization. Some 84% lived in urban areas and 16% in rural areas.
The chartbook used a narrower definition than CMS's own HCBS reports, so its 3.3 million is slightly less than half of the people CMS counts as HCBS users.
Providers and services
The number of billing providers grew from 2019 to 2021 and stayed mostly flat through 2023, while participants kept rising, so the number per provider increased every year. Personal care was the most used service, accounting for 62.7% of home care claims.
What the 2025 law could change
The chartbook projects that by 2034, 311,879 fewer people who use home care will be eligible for Medicaid because of the 2025 reconciliation law, 9.4% below baseline, due to changes such as more frequent eligibility checks and work requirements. It estimates 75,381 home care users, 2.3%, will face new mandatory cost-sharing.
Why this matters for providers and DSPs
More people are seeking home care per provider, which strains agencies already short on staff. Coverage losses ahead could shrink demand in some states even as need remains, making planning harder.