Best Practices
Which states have the best home health star ratings in 2026?
Enzo Health Team6 min readThe best home health star ratings in 2026 are in Alabama, where 62.3% of its 114 rated agencies have 4 quality stars or more, against 34.7% nationally.
Direct answer
Alabama leads on Care Compare's quality of patient care star rating: 62.3% of its 114 rated agencies have 4 stars or more, against 34.7% of rated agencies nationally. Six states have more than half their rated agencies at 4 stars or more: Alabama, South Carolina, South Dakota, Tennessee, New Jersey and Utah. Several of those have fewer than 70 rated agencies, so a handful of agencies moves their numbers.
Six of the seven biggest states sit below the national share
California, Texas, Ohio, Illinois, Pennsylvania and Michigan are all under 34.7%.
A strong star share doesn't guarantee a value-based purchasing increase
Georgia has 48.0% of rated agencies at 4 stars or more and a median 2026 adjustment of -0.61%.
What the star rating measures, and how to check yours
Care Compare gives each agency two star ratings. This page ranks the quality of patient care star rating, built from OASIS and Medicare claims measures. The other is the patient survey star rating, from HHCAHPS.
Nationally, the average agency has 3 quality stars and 34.7% of rated agencies have 4 or more. To see where yours sits:
- Look up your agency on Medicare's Care Compare by name or ZIP code, and note your quality star rating.
- Find your state in the table below and put your rating next to the state's average and its share at 4 stars or more.
Home health star ratings in every state
States are ranked by the share of rated agencies with 4 quality stars or more. The last column is the share of patients who rated their agency 9 or 10.
CMS Care Compare, October 2026 release; quality of patient care star rating; patient survey April 2025 to March 2026. Guam, the Northern Mariana Islands and the US Virgin Islands have 3 or 4 agencies each and are left out.
| State | Rated agencies | Avg. stars | At 4+ stars | Rated 9 or 10 |
|---|---|---|---|---|
| Alabama | 114 | 4 | 62.3% | 90% |
| South Carolina | 64 | 4 | 60.9% | 89% |
| South Dakota | 21 | 4 | 57.1% | 89% |
| Tennessee | 111 | 3.5 | 55.9% | 88% |
| New Jersey | 38 | 3.5 | 55.3% | 85% |
| Utah | 63 | 4 | 54.0% | 87% |
| Delaware | 12 | 3.5 | 50.0% | 86% |
| Louisiana | 161 | 3.5 | 49.7% | 90% |
| Georgia | 98 | 3.5 | 48.0% | 87% |
| Maine | 19 | 3.5 | 47.4% | 90% |
| Mississippi | 42 | 3.5 | 45.2% | 90% |
| West Virginia | 42 | 3.5 | 45.2% | 87% |
| Maryland | 47 | 3.5 | 44.7% | 83% |
| Oklahoma | 170 | 3.5 | 44.1% | 88% |
| Florida | 762 | 3.5 | 43.4% | 85% |
| North Carolina | 152 | 3.5 | 43.4% | 89% |
| Puerto Rico | 35 | 3.5 | 42.9% | 85% |
| Arizona | 128 | 3.5 | 41.4% | 84% |
| Kentucky | 85 | 3.5 | 41.2% | 90% |
| District of Columbia | 10 | 3.5 | 40.0% | 70% |
| New York | 90 | 3.5 | 38.9% | 83% |
| Wisconsin | 61 | 3.5 | 37.7% | 84% |
| Oregon | 44 | 3 | 36.4% | 84% |
| Nebraska | 47 | 3.5 | 36.2% | 87% |
| Kansas | 83 | 3.5 | 36.1% | 88% |
| New Mexico | 61 | 3.5 | 34.4% | 87% |
| Washington | 62 | 3.5 | 33.9% | 84% |
| Missouri | 104 | 3.5 | 33.7% | 87% |
| California | 2,090 | 3 | 32.1% | 83% |
| New Hampshire | 22 | 3.5 | 31.8% | 89% |
| Texas | 1,006 | 3 | 31.1% | 87% |
| Michigan | 267 | 3.5 | 30.3% | 84% |
| Indiana | 122 | 3 | 30.3% | 85% |
| Arkansas | 85 | 3.5 | 29.4% | 89% |
| Illinois | 421 | 3 | 28.5% | 84% |
| Virginia | 179 | 3.5 | 28.5% | 85% |
| Colorado | 107 | 3 | 28.0% | 87% |
| Rhode Island | 18 | 3 | 27.8% | 89% |
| Pennsylvania | 183 | 3.5 | 27.3% | 89% |
| Wyoming | 22 | 3 | 27.3% | 85% |
| Ohio | 244 | 3 | 27.0% | 86% |
| Idaho | 45 | 3.5 | 26.7% | 86% |
| Minnesota | 92 | 3 | 25.0% | 85% |
| Nevada | 157 | 3 | 24.8% | 81% |
| Connecticut | 58 | 3 | 24.1% | 85% |
| Massachusetts | 119 | 3 | 23.5% | 83% |
| Iowa | 90 | 3 | 23.3% | 87% |
| Montana | 19 | 2.5 | 21.1% | 89% |
| Hawaii | 14 | 3 | 14.3% | 87% |
| North Dakota | 13 | 3 | 7.7% | 88% |
| Alaska | 11 | 3 | 0.0% | 87% |
| Vermont | 9 | 3 | 0.0% | 87% |
Alabama, South Carolina, Tennessee, Louisiana, Georgia and Mississippi all sit in the top 11, and in each of them 87% to 90% of patients rate their agency 9 or 10, against 85% nationally.
Only Florida, of the biggest states, beats the national share
Seven states have 300 or more agencies, and together they hold about two thirds of the country's agencies in Care Compare (8,326 of 12,409). Florida is the only one above the national 34.7%, at 43.4%. The other six sit between 27.0% and 32.1%: California 32.1%, Texas 31.1%, Michigan 30.3%, Illinois 28.5%, Pennsylvania 27.3% and Ohio 27.0%.
We've looked at three of them more closely: California, where more than half of agencies were certified in 2020 or later; Texas, where fewer patients stay home after discharge; and Florida, where quality stars and survey stars point different ways.
Star ratings and value-based purchasing measure different things
Under Home Health Value-Based Purchasing (HHVBP), Medicare's pay-for-quality program, each scored agency's payments go up or down by up to 5%. The 2026 adjustments were set by 2024 performance on HHVBP's own measures, so a state's star share and its adjustment can point different ways. Alabama has 62.3% at 4 stars or more and a median adjustment of +1.24%. Georgia has 48.0% and -0.61%; New Jersey has 55.3% and -0.40%. Our chapter on what HHVBP does to your payment walks through the measures and the dollars.
Enzo is a home health EHR. The quality star rating draws on two kinds of measures: OASIS measures, like improvement in bathing and in shortness of breath, and a Medicare claims measure, preventable hospitalizations. Enzo's tools work on the OASIS side, where the answers a clinician records are the data. Enzo Scribe turns the visit into complete, OASIS-ready notes and flags gaps against OASIS requirements before anything goes to review. Enzo QA reviews every chart before submission, including OASIS responses and Plan of Care alignment, and explains what needs attention and why.
Questions agencies are asking
Nationally, the average agency has 3 quality stars and 34.7% of rated agencies have 4 or more. In Alabama, the top state, 62.3% do.
8,126 of the 12,409 agencies in Care Compare have one in this release. For 3,968 of the rest, CMS's footnote says the number of patient episodes is too small to report. For 315, the measure has no data yet or the agency was certified or recertified less than 6 months ago.
No. The quality of patient care star rating comes from OASIS and claims measures. The patient survey star rating comes from HHCAHPS, the patient experience survey. Care Compare shows both.
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