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Documentation in Long-Term and Home Healthcare Setting01:29

Documentation in Long-Term and Home Healthcare Setting

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Medicare Advantage Prior-Authorizations Are Linked to Racial Differences in End-of-Life Home Health Use.

Tessa Jones1,2, Mohamed K Benyamine2, Evan Bollens-Lund1

  • 1Icahn School of Medicine at Mount Sinai, New York, New York, USA.

Journal of the American Geriatrics Society
|July 7, 2026
PubMed
Summary

Prior authorization in Medicare Advantage plans widens racial and ethnic disparities in home health care access for older adults nearing end of life.

Keywords:
health care utilizationhome health caremedicare advantageprior authorization

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Published on: January 8, 2020

Area of Science:

  • Health Services Research
  • Health Equity
  • Gerontology

Background:

  • Medicare-funded home health care is vital for homebound older adults, particularly those in their last year of life.
  • Existing disparities show Hispanic and Asian/Pacific Islander decedents are less likely to use Medicare home health in Medicare Advantage compared to traditional Medicare.
  • Racial and ethnic disparities in end-of-life care access are a significant concern within Medicare Advantage.

Purpose of the Study:

  • To investigate whether prior authorization policies contribute to racial and ethnic disparities in Medicare home health care utilization among decedents in Medicare Advantage.
  • To quantify the impact of prior authorization on the utilization of home health services by different racial and ethnic groups at the end of life.

Main Methods:

  • A cross-sectional study analyzed a 100% Medicare cohort of adults aged 66 and older who died in 2019 and were enrolled in Medicare Advantage.
  • Logistic regression models, including plan-level fixed effects, were used to assess the interaction between decedent race/ethnicity and prior authorization requirements.
  • Models were adjusted for individual and regional characteristics to isolate the effect of prior authorization.

Main Results:

  • The study included 369,195 decedents, with 65.1% enrolled in plans requiring prior authorization for home health care.
  • Prior authorization was found to exacerbate racial and ethnic differences in home health utilization, primarily through between-plan variations.
  • Specifically, prior authorization was associated with decreased utilization for Hispanic individuals (5.60%) and Asian/Pacific Islanders (4.05%).

Conclusions:

  • Prior authorization policies in Medicare Advantage plans are a contributing factor to racial and ethnic disparities in home health care access.
  • These findings highlight the need to re-evaluate prior authorization practices to promote health equity in end-of-life care.
  • Addressing these disparities is crucial for ensuring equitable access to essential home health services for all Medicare beneficiaries.