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Medicaid programs in some states have attempted to shift home health care costs to Medicare by using retrospective billing practices. The authors explored whether retrospective billing practices increase Medicare utilization for dual eligibles by analyzing primary data on the existence of retrospective billing practices collected from 47 state Medicaid offices complemented with individual-level secondary data from the 1992-1997 Medicare Current Beneficiary Survey. An individual-level random effects model was used to estimate the increase in the probability and amount of Medicare home care visits from state retrospective billing practices. Retrospective billing practices were found not to affect either the probability or the amount of Medicare home care visits in these data, but the significant inverse relationship found between Medicaid and Medicare visits shows that states with high Medicaid utilization have opportunity to shift some of these visits to Medicare.

Racial and ethnic disparities are found in many health care settings; however, there is little prior research on such disparities among patients receiving home health care services. This study used 2012 Home Health Care CAHPS® data to identify any overall patient-level disparities in self-reported experience of care and to decompose these disparities according to whether they result from within-agency versus between-agency differences. Although patient experience of care ratings were high across all groups, the study identified consistently lower ratings for all minority groups on two of three Home Health Care CAHPS measures, with Asians reporting the greatest disparities. Three quarters of disparities were found to be within-agency disparities, which were primarily related to care processes and provider/patient communications rather than to specific health care services received. Despite high ratings in general, home health agencies may need to focus on cultural competency initiatives to address racial and ethnic disparities within their agencies.