Disclaimer: General educational research only — not legal, tax or financial advice. Rules differ by state and by family. Talk to an estate planning attorney in your state before you act.
Estate Planning Data & Research → Home Health Quality by State
Most older adults who need help at home after a hospital stay get it from a Medicare-certified home health agency. Quality varies by state. Medicare’s own star ratings show that, and the moment a family starts choosing an agency is also when it often finds out no one has legal authority to make decisions for the patient.
This page shows Medicare’s home health quality ratings for every state and D.C., from the Centers for Medicare & Medicaid Services (CMS).
Choosing care is a good time to put the rest of the plan in place too. See how a trust and a will differ.
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Cite this page URL when reusing findings. Not a substitute for official sources or professional advice.
Key findings
- The average state quality-of-patient-care rating is 3.34 stars out of 5 across the 50 states and D.C. (CMS Home Health Care State by State Data, July 2026 file).
- Alabama, Maryland, New Jersey, South Carolina and Tennessee have the highest state rating, 4.0 stars. Montana has the lowest, 2.5 stars. 26 jurisdictions are at 3.5 and 19 at 3.0.
- The share of agencies rated 4 stars or higher is largest in Alabama (61.2%), New Jersey (60.5%), South Carolina (57.4%).
- In Alaska and Vermont, no rated agency reached 4 stars or higher in this file.
Home health quality by state
| State | State quality star rating | Agencies rated 4-5 stars (%) | Agencies rated 1-2 stars (%) | Care started on time (%) | Improved at walking (%) |
|---|---|---|---|---|---|
| Alabama | 4 | 61.2 | 5.2 | 99.14 | 94.04 |
| Alaska | 3 | 0.0 | 21.4 | 86.96 | 80.19 |
| Arizona | 3.5 | 29.4 | 11.3 | 97.29 | 86.60 |
| Arkansas | 3.5 | 32.6 | 8.7 | 97.36 | 90.17 |
| California | 3 | 20.7 | 13.9 | 95.34 | 83.39 |
| Colorado | 3 | 14.4 | 16.2 | 95.63 | 84.96 |
| Connecticut | 3 | 20.8 | 13.9 | 95.57 | 88.04 |
| Delaware | 3.5 | 27.3 | 9.1 | 96.51 | 93.28 |
| District of Columbia | 3.5 | 11.4 | 8.6 | 91.51 | 86.52 |
| Florida | 3.5 | 27.9 | 8.0 | 97.99 | 89.63 |
| Georgia | 3.5 | 42.9 | 3.8 | 97.61 | 91.21 |
| Hawaii | 3 | 11.1 | 16.7 | 90.71 | 78.15 |
| Idaho | 3.5 | 25.0 | 8.3 | 98.59 | 89.76 |
| Illinois | 3 | 24.1 | 21.9 | 96.67 | 85.40 |
| Indiana | 3 | 22.0 | 16.2 | 96.55 | 90.42 |
| Iowa | 3 | 15.2 | 18.4 | 96.98 | 88.23 |
| Kansas | 3.5 | 25.9 | 12.0 | 98.23 | 89.02 |
| Kentucky | 3.5 | 44.3 | 6.8 | 97.61 | 90.51 |
| Louisiana | 3.5 | 50.0 | 8.0 | 99.01 | 90.79 |
| Maine | 3.5 | 31.6 | 5.3 | 94.51 | 93.11 |
| Maryland | 4 | 43.1 | 0.0 | 97.21 | 90.41 |
| Massachusetts | 3 | 9.4 | 10.4 | 96.52 | 89.75 |
| Michigan | 3.5 | 24.5 | 7.8 | 96.74 | 89.64 |
| Minnesota | 3 | 16.7 | 15.9 | 96.49 | 85.54 |
| Mississippi | 3.5 | 50.0 | 4.8 | 97.67 | 91.30 |
| Missouri | 3.5 | 36.7 | 13.3 | 98.20 | 90.74 |
| Montana | 2.5 | 19.0 | 38.1 | 94.05 | 80.94 |
| Nebraska | 3.5 | 25.8 | 8.1 | 97.97 | 88.91 |
| Nevada | 3 | 17.1 | 25.4 | 95.36 | 82.13 |
| New Hampshire | 3.5 | 22.2 | 7.4 | 97.74 | 93.11 |
| New Jersey | 4 | 60.5 | 0.0 | 93.00 | 92.78 |
| New Mexico | 3.5 | 32.9 | 17.1 | 96.61 | 88.93 |
| New York | 3.5 | 36.0 | 5.0 | 97.81 | 90.58 |
| North Carolina | 3.5 | 42.8 | 2.4 | 98.17 | 91.74 |
| North Dakota | 3 | 10.0 | 0.0 | 97.16 | 87.09 |
| Ohio | 3 | 7.1 | 6.5 | 96.09 | 89.16 |
| Oklahoma | 3 | 28.3 | 17.9 | 96.99 | 89.27 |
| Oregon | 3 | 29.4 | 15.7 | 88.66 | 85.44 |
| Pennsylvania | 3.5 | 13.3 | 4.3 | 95.85 | 91.00 |
| Rhode Island | 3 | 27.3 | 4.5 | 95.74 | 88.72 |
| South Carolina | 4 | 57.4 | 0.0 | 98.04 | 93.68 |
| South Dakota | 3.5 | 52.2 | 13.0 | 99.10 | 88.77 |
| Tennessee | 4 | 47.7 | 4.7 | 97.48 | 92.62 |
| Texas | 3 | 16.3 | 18.1 | 96.76 | 85.70 |
| Utah | 3.5 | 42.7 | 3.7 | 98.98 | 91.46 |
| Vermont | 3 | 0.0 | 0.0 | 93.44 | 89.44 |
| Virginia | 3.5 | 23.2 | 9.3 | 96.80 | 88.40 |
| Washington | 3.5 | 40.5 | 5.4 | 87.69 | 87.07 |
| West Virginia | 3.5 | 48.8 | 4.7 | 97.14 | 92.35 |
| Wisconsin | 3.5 | 31.0 | 11.5 | 95.59 | 89.09 |
| Wyoming | 3 | 12.5 | 18.8 | 95.91 | 83.09 |
Source: CMS Provider Data Catalog, Home Health Care – State by State Data (dataset tee5-ixt5), July 2026 file. Star percentages are the share of rated agencies in the state at each star level.
What this means if you’re planning
- Name a health care agent now. If a parent can’t make decisions, someone needs written authority to choose and talk to an agency. See the incapacity gap.
- Add a durable financial power of attorney so someone can pay bills and handle insurance. See power of attorney abuse watch for safeguards.
- Know the cost picture. See home care cost vs. retirement income and the caregiver shortage index.
- Write down end-of-life wishes. See end-of-life wishes by state.
Related: nursing home capacity · family caregiver value
Methodology
CMS Provider Data Catalog, “Home Health Care – State by State Data” (tee5-ixt5), pulled from the CMS API on Oct. 12, 2026 (distribution HH_State_Jul2026.csv; dataset metadata modified May 27, 2026). The state star rating is the CMS quality-of-patient-care star rating reported for each state. “Agencies rated 4-5 stars” sums the 4, 4.5 and 5-star percentages; “1-2 stars” sums 1, 1.5 and 2. The average is a simple mean of the 51 state ratings, not weighted by patients. Territories are excluded.
What this doesn’t measure. Patient-survey (HHCAHPS) ratings, cost to families, or availability of agencies in rural areas.
Frequently asked questions
How are home health agencies rated?
CMS gives agencies a quality-of-patient-care star rating based on measures such as timely starts of care and patient improvement.
Which states have the best home health ratings?
In the July 2026 file, Alabama, Maryland, New Jersey, South Carolina, Tennessee have a 4.0 state rating.
What documents do I need before choosing in-home care for a parent?
Typically a health care proxy or directive and a durable financial power of attorney, so someone can act if the parent can’t.
Is this medical or legal advice?
No.
Sources
Public-domain government sources only. Fetched 2026-10-12.
Data
- CMS Provider Data Catalog, Home Health Care – State by State Data (tee5-ixt5): https://data.cms.gov/provider-data/dataset/tee5-ixt5
- API: https://data.cms.gov/provider-data/api/1/datastore/query/tee5-ixt5/0
Cite this data
Family Estate Guide, “Home Health Care Quality by State: Medicare Star Ratings,” October 2026. https://familyestateguide.com/estate-planning-data/home-health-quality-by-state/
You’re welcome to reuse the table with a link back to this page. The underlying government data is public.
Published October 12, 2026 by Family Estate Guide. Data vintage: CMS Home Health State by State Data, July 2026 file. Editorial standards.