Mar 31, 2026
- Study published in JAMA Open Network analyzes post-acute care quality for more than 44,000 Medicare stroke patients
- Medicare Advantage and dual-eligible patients were less likely to receive care from high-quality skilled nursing facilities and home health agencies
- Findings highlight growing disparities as Medicare Advantage enrollment continues to expand
Every 40 seconds, someone in the United States experiences a stroke, and for survivors, the crisis does not end at hospital discharge. A new study published in JAMA Open Network reveals that what happens next: access to high-quality post-acute stroke care varies significantly based on insurance type, with potentially life-altering consequences for recovery and long-term independence.
The study, “Association of Dual Eligibility and Medicare Type With Quality of Post-acute Care After Stroke,” examined outcomes for 44,078 Medicare beneficiaries hospitalized for ischemic stroke between 2021 and 2022. Led by University of Utah researcher Amit Kumar, PhD, MPH, the research found that patients enrolled in Medicare Advantage (MA) plans and those with dual eligibility (enrolled in both Medicare and Medicaid) were significantly less likely to be discharged to high-quality post-acute care compared to patients enrolled in traditional Medicare Fee-for-Service (FFS).
Post-acute care, including inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health services, plays a critical role in stroke recovery. These services help restore mobility, rebuild independence, prevent complications, and reduce hospital readmissions. However, the U.S. post-acute care system remains fragmented, with inconsistent quality oversight and reimbursement structures that influence where patients receive care.
Using the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System, researchers classified SNFs with one to three stars as low quality and four to five stars as high quality. Home health agencies were classified as low quality if rated four stars or fewer. Because CMS does not provide star ratings for IRFs, quality was assessed using potentially preventable hospital readmission rates.
The findings showed that Medicare Advantage and dual-eligible patients were significantly less likely to receive care from high-quality SNFs. MA patients were also less likely to be discharged to high-quality home health agencies. No significant differences were found in IRF quality, underscoring gaps in standardized quality measurement for those facilities.
“These differences can directly affect recovery, long-term independence, and survival for stroke patients, especially dual eligibles, enrolled in Medicare Advantage plans, as they are already facing socioeconomic and health disadvantages,” Kumar said.
The disparities were most pronounced among dual-eligible beneficiaries enrolled in Medicare Advantage plans—a rapidly growing and highly vulnerable population. Medicare Advantage now covers more than 54% of all Medicare beneficiaries, driven in large part by dual-eligible individuals with complex medical needs.
The study raises concerns that cost-containment strategies, narrow provider networks, and utilization controls within Medicare Advantage may be limiting access to high-quality rehabilitation services, particularly in rural and underserved communities.
“Access to high-quality post-acute care should not depend on insurance type,” Kumar said. “As Medicare Advantage and dual enrollment continue to expand, policymakers and healthcare systems must ensure that cost-efficiency strategies do not come at the expense of care quality and patient outcomes.”
The research highlights the need for stronger oversight of Medicare Advantage provider networks, greater transparency in post-acute care quality ratings, improved discharge planning education, and increased awareness of CMS star ratings among patients, caregivers, and providers. More information about post-acute care quality ratings is available through CMS’s Medicare Care Compare website.
Kumar and his research team are now conducting qualitative studies to examine whether Medicare star ratings are actively used during real-world discharge planning and how they influence referral decisions and access to high-quality care for stroke survivors.
