cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
cms-provider-data-catalog · CMS
CMS keeps a running map of where Medicare providers are thickest on the ground. The Market Saturation & Utilization State-County files, published through the agency's data catalog, count — for each county, each state, and the nation, across 24 service categories — how many providers bill Medicare fee-for-service, how many beneficiaries live there, and how many of those beneficiaries actually use the service. Divide the first by the second and you get a saturation rate: providers per 1,000 beneficiaries. CMS built the measure for one purpose — program-integrity monitoring. It is the agency's own early-warning tool for markets where the supply of a service has run ahead of the population that needs it. Read the latest map and one market stands out above every other.
Los Angeles is the most saturated home health market in the country
In the 2025 reference period, 1,847 home health agencies served Los Angeles County's Medicare population — the most of any county in the United States, and more than five times the next-highest county. Against the county's 872,904 fee-for-service beneficiaries that works out to 2.12 agencies per 1,000 beneficiaries, against a national rate of 0.215 — a 9.9-fold concentration.
The gap is not a quirk of one large county. Rank every county with a substantial Medicare base by its home health saturation rate and a clear corridor appears: Southern California and the Texas border.
| County | State | Agencies | FFS beneficiaries | Agencies / 1,000 |
|---|---|---|---|---|
| Los Angeles | CA | 1,847 | 872,904 | 2.12 |
| Imperial | CA | 45 | 26,919 | 1.67 |
| San Bernardino | CA | 214 | 146,380 | 1.46 |
| Guadalupe | TX | 31 | 22,179 | 1.40 |
| Cameron (Brownsville) | TX | 35 | 25,623 | 1.37 |
| Hidalgo (McAllen) | TX | 52 | 39,799 | 1.31 |
| Grayson | TX | 26 | 20,323 | 1.28 |
| Ventura | CA | 132 | 114,695 | 1.15 |
| Dallas | TX | 232 | 202,655 | 1.14 |
Source: CMS Market Saturation & Utilization, home health, the nine most-saturated counties with at least 20,000 FFS beneficiaries, 2025 reference period.
Market saturation is the ratio of providers to beneficiaries, and CMS publishes it to watch for places where supply has run ahead of need. It is an oversight signal — a reason to look — never, on its own, a finding of fraud.
These are the same markets that have historically drawn the most scrutiny for Medicare home health billing. That is precisely why CMS publishes the measure: home health is a low-overhead, high-volume category where a dense cluster of agencies in one county is worth a second look. The map does not say anything is wrong in Los Angeles or McAllen. It says these are the places the program watches.
Reading a county count correctly
One number above needs care. CMS counts a provider in every county where it serves at least one beneficiary, so a county's agency count is a count of presences, not of distinct firms. Sum the home health agency counts across all counties and you get 23,311 — but the nation has only 8,488 distinct home health agencies. The average agency therefore shows up in roughly 2.75 counties.
That is why this study compares saturation rates across geographies rather than treating a county's raw count as a slice of the national total. "1,847 agencies serve Los Angeles County" is exact; "Los Angeles has 22% of the nation's agencies" would not be — many of those 1,847 also serve neighboring Orange, San Bernardino, or Riverside counties. The rate is the comparable quantity, and on the rate Los Angeles still leads the country.
The category pattern: home health and DME
Step back to the national level and the saturation measure sorts Medicare's service categories into two very different shapes. Physician categories carry hundreds of thousands of clinicians and so post the highest national provider-to-beneficiary ratios — preventive health services at 5.70 per 1,000, pulmonology at 4.56. But those providers are spread thinly across every county. The program-integrity story lives in the supplier categories, where a relative handful of national firms cluster densely in specific places.
| Category | Providers (national) | FFS beneficiaries | Providers / 1,000 | FFS payment |
|---|---|---|---|---|
| Durable medical equipment | 45,963 | 39,598,270 | 1.16 | $27.0B |
| Home health | 8,488 | 39,524,879 | 0.22 | $16.0B |
| Hospice | 5,024 | 39,475,379 | 0.13 | $15.4B |
| Skilled nursing facility | 12,919 | 39,391,060 | 0.33 | $27.9B |
Source: CMS Market Saturation & Utilization, NATION + TERRITORIES aggregation, 2025 reference period.
Durable medical equipment repeats the home health pattern in a different geography. Its national rate is 1.16 suppliers per 1,000 beneficiaries, but in the most concentrated large counties it runs roughly three times that: 3.45 in Fort Bend County, Texas, 3.43 in Will County, Illinois, and 3.41 in Pasco County, Florida. Home health and DME are not on this list by accident — they are the two categories CMS and the HHS Office of Inspector General have monitored most closely for over-saturation, and the 2013-2019 enrollment moratoria targeted exactly them.
The states behind the clusters
Roll the county figures up to the state level and California sits at the top of the home health ranking by a wide margin.
| State | Agencies | FFS beneficiaries | Agencies / 1,000 |
|---|---|---|---|
| California | 2,451 | 4,060,783 | 0.604 |
| Nevada | 186 | 359,599 | 0.517 |
| Texas | 1,012 | 2,727,697 | 0.371 |
| Oklahoma | 188 | 559,930 | 0.336 |
| Illinois | 466 | 1,592,064 | 0.293 |
| Florida | 775 | 2,750,107 | 0.282 |
Source: CMS Market Saturation & Utilization, home health, STATE aggregation, 2025 reference period.
California's 0.604 agencies per 1,000 beneficiaries is nearly triple the national rate and the highest of any state; Nevada and Texas follow. These are the states whose metros — Los Angeles, Las Vegas, the Rio Grande Valley, Dallas-Fort Worth — generate the dense county clusters above. Florida and Illinois, the other two states named in the historical moratoria, sit just behind.
The moratorium flag is empty — and that matters
Every record in the file carries a moratorium flag, a holdover from the period when CMS used its statutory authority to freeze new enrollments in over-saturated markets. In this snapshot the flag is inactive everywhere: of the 68,068 latest-period records, none reads "Yes" — 68,044 read "No" and the other 24 are blank — and across all 15 yearly snapshots in the table the only values the field ever takes are "No" and blank. There is no county, state, or category currently under an enrollment moratorium in this data.
CMS imposed temporary statewide moratoria on new home health and Part B ground-ambulance enrollments in several states — Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey among them — between 2013 and 2019, using authority created by the Affordable Care Act to target fraud-prone, over-saturated markets. It lifted the last of them in January 2019 and has not re-imposed any since. The flag remains in the file as a field; it simply has no active value to report.That empty flag is the honest frame for everything above. A high saturation rate today is not an enforcement action and is not paired with one — it is the raw input CMS watches, the thing that precedes any decision to scrutinize a market. The map tells you where supply is densest. It does not tell you why, and it never names who.
What one row actually is
Each row in cms_market_saturation is one market: a county, state, or the nation, for one service category, in one reference period, carrying its provider count, beneficiary count, user count, average users per provider, total fee-for-service payment, and the moratorium flag. Counting and dividing those rows is the entire method here. The data CMS publishes is aggregate by construction — it reports how many providers and beneficiaries are in a market, never which ones — so no count or ratio in this study names, ranks, or scores any individual agency, supplier, or clinician. The unit of analysis is the market, not the firm.
Methodology
All figures are aggregations over the cms_market_saturation table, populated from the CMS Market Saturation & Utilization State-County files published through the CMS data catalog (data.cms.gov, Program Integrity > Market Saturation by Type of Service). The table holds 1,030,290 rows spanning 15 yearly reference periods (2020 through 2025), 24 service categories, and three aggregation levels — NATION + TERRITORIES, STATE, and COUNTY (3,141 counties). Snapshot release 2025-12-01; public, read-only; license US-Government-Works.
This study reads only the most recent annual period — reference_period = '2025-01-01 to 2025-12-31', 68,068 records — resolved as max(reference_period) at query time rather than hard-coded, so the figures advance when CMS publishes the next file. The saturation rate is number_of_providers / number_of_ffs_beneficiaries * 1000, computed per row; national, state, and county figures read the matching aggregation_level. County provider counts are presences, not distinct firms, because CMS counts a provider in every county it serves — so cross-geography comparisons use the rate, and county-versus-national counts are never differenced. Because these are direct counts and ratios over a published aggregate table, every figure is exact as of the snapshot rather than estimated. Methodology version: market-saturation/v1. The source-provenance contract is documented in the provenance methodology.
Limitations
- A monitoring signal, not a finding of fraud. Market saturation is the input CMS watches for program integrity, not an output. A high provider-to-beneficiary ratio is a reason to look at a market; it is never, on its own, evidence that any billing, agency, or supplier is improper. This study makes no fraud claim about any place or party.
- Aggregate and geography-level only. The CMS files are aggregate by construction. Every figure here is a count or ratio at the county, state, or national level; no individual provider, supplier, or clinician is named, ranked, or scored.
- County counts are presences, not firms. CMS counts a provider in every county where it serves a beneficiary, so county provider counts overlap and their sum exceeds the national distinct count. Raw county counts describe local presence, not a share of any national total.
- Saturation is not utilization or spending. The provider-to-beneficiary ratio says nothing by itself about how much care is delivered or billed. A saturated market may be high- or low-volume; the payment and user columns are reported alongside but are not the saturation measure.
- Snapshot, not a trend. Figures reflect the most recent annual period in the 2025-12-01 snapshot. CMS revises and extends the series, so rates shift between releases; this study does not model change over time.
- The moratorium flag is inactive. Every row in this snapshot reads "No," reflecting that all 2013-2019 enrollment moratoria were lifted. The flag is reported for completeness, not as a live enforcement state.
- Counts reflect enrollment, not quality. A provider appears in a market because it is enrolled and billing there, not because of any assessment of the care it provides. Saturation is a supply measure; it carries no quality signal.
Sources
- CMS — Market Saturation by Type of Service (Program Integrity) — the State-County public-use files behind every figure in this study.
- CMS — Market Saturation & Utilization State-County tool — CMS's interactive map and the agency's own description of how the measure is used for program-integrity monitoring.
- CMS — Medicare provider enrollment — the enrollment program under which the historical temporary moratoria were imposed and lifted.
The companion dataset page for CMS Market Saturation lists the full schema and refresh cadence. This is the oversupply mirror of the rural care deserts where providers are scarcest and of the March deactivation spike that thinned shortage-area supply; for who is enrolled to bill Medicare in the first place see the changing shape of Medicare enrollment, and for the program-integrity end of the same system, the providers excluded from Medicare yet still enrolled and the 5% of prescribers behind half of Medicare's drug bill.
Frequently asked questions
- What is Medicare 'market saturation'?
- Market saturation is the ratio of Medicare providers or suppliers to fee-for-service beneficiaries in a given area and service category — in practice, providers per 1,000 beneficiaries. CMS publishes it through the Market Saturation & Utilization State-County tool so it can watch for places where the supply of a service has run well ahead of the population that needs it. A high ratio is a reason to look more closely; it is not, on its own, evidence that anything is wrong.
- Which county has the most Medicare home health agencies?
- Los Angeles County. In the 2025 reference period it was served by 1,847 home health agencies — far more than any other county and five times the next-highest (Cook County, Illinois, at 365). Measured against its Medicare population, that is 2.12 agencies per 1,000 fee-for-service beneficiaries, 9.9 times the national rate of 0.215. The Texas border counties around McAllen (Hidalgo) and Brownsville (Cameron) carry the next-highest large-county rates.
- Does high market saturation mean there is Medicare fraud?
- No. Saturation is an oversight and monitoring signal, not a finding. CMS built the measure to flag markets worth watching for program integrity, because some historically over-saturated categories — home health and durable medical equipment in particular — have also seen high rates of improper billing. But a high ratio can equally reflect a large referral hub, an aging population, or many small agencies. This study reports geography-level ratios only and names no provider.
- Why is home health and DME singled out?
- Home health and durable medical equipment are low-overhead, high-volume Medicare categories where a single supplier can serve beneficiaries across a wide area, so they have historically attracted dense clusters of enrollees. CMS and the HHS Office of Inspector General have long monitored both for over-saturation, and the 2013-2019 enrollment moratoria targeted exactly these categories in specific metros. They top the county saturation ranking here as well.
- Are there any Medicare enrollment moratoria in force right now?
- Not in this data. None of the 68,068 latest-period records carries an active moratorium: 68,044 read "No" and the other 24 are blank, and across all 15 yearly snapshots the only values the flag ever takes are "No" and blank. CMS imposed temporary statewide moratoria on new home health and ground-ambulance enrollments in several states between 2013 and 2019, then lifted all of them in January 2019. The flag remains in the file as a field, but it is inactive everywhere in this snapshot.
- Does this study name any agency, supplier, or clinician?
- No. Every figure is a count or ratio at the county, state, or national level. The data CMS publishes is itself aggregate — it reports how many providers and beneficiaries are in a market, never which ones — so there is no individual provider to name, rank, or score anywhere in this study.
- Can I reproduce these figures?
- Yes. Every number aggregates the public cms_market_saturation table (1,030,290 rows from the CMS Market Saturation & Utilization State-County files, snapshot release 2025-12-01) over its most recent annual period. The exact SQL — the national baselines, the county and state saturation rates, and the moratorium-flag check — is published in the reproducibility block below.
Who uses this data
The source data behind this study is public
Compliance teams, journalists, and researchers work from the same federal source families cited above — queried by NPI or facility identifier through Fonteum’s open dataset pages and API. Every figure traces to a frozen, downloadable snapshot you can reproduce yourself.
Datasets used
Reproducibility
Every claim, reproducible
The SQL
-- Medicare provider market saturation as a program-integrity signal —
-- fully reproducible query.
--
-- Question: where do Medicare fee-for-service (FFS) providers and suppliers
-- cluster far past what local beneficiary demand explains? We measure, over
-- the most recent annual reference period, the provider-to-beneficiary ratio
-- (providers per 1,000 FFS beneficiaries) by service category and by county —
-- the same "market saturation" metric CMS itself publishes for program-
-- integrity MONITORING. High saturation is a risk/oversight signal, NOT proof
-- of fraud. The lead figure is Los Angeles County's home health saturation:
-- 1,847 agencies, 2.12 per 1,000 FFS beneficiaries, ~9.9x the national rate.
--
-- Source:
-- public.cms_market_saturation — CMS Market Saturation & Utilization
-- State-County, published via the CMS data catalog (data.cms.gov),
-- Program Integrity > Market Saturation by Type of Service.
-- 1,030,290 rows across 15 yearly reference periods (2020-2025), 24 service
-- categories, and three aggregation levels (NATION + TERRITORIES, STATE,
-- COUNTY = 3,141 counties). Snapshot release 2025-12-01; public, read-only.
-- License: US-Government-Works (17 U.S.C. Sec. 105).
-- methodology_version = 'cms-market-saturation/v1'.
--
-- Universe: this study reads the LATEST annual period only
-- (reference_period = '2025-01-01 to 2025-12-31', 68,068 rows) so every
-- figure is point-in-time, not a trend. The period is resolved as
-- max(reference_period) at query time, never hard-coded, so the figures
-- advance when CMS publishes the next file.
--
-- Counting note (CRITICAL): CMS counts a provider in EVERY county where it
-- serves at least one beneficiary, so county provider counts are presences,
-- not distinct firms — the sum of county counts exceeds the national DISTINCT
-- count (home health: 23,311 county presences vs 8,488 distinct agencies).
-- We therefore compare the saturation RATE (providers per 1,000 FFS benes)
-- across geographies, and label raw county counts as "agencies serving the
-- county," never as a share of the national total.
-- ============================================================================
-- (1) National saturation by service category, latest period.
-- providers_per_1k = number_of_providers / FFS beneficiaries * 1000.
-- Home health and DME are the categories CMS singles out for program-
-- integrity monitoring; the national home health rate (0.215) is the
-- baseline the county figures are measured against.
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
type_of_service,
number_of_providers::bigint AS providers,
number_of_ffs_beneficiaries::bigint AS ffs_benes,
number_of_users::bigint AS users,
average_users_per_provider AS users_per_provider,
total_payment::bigint AS total_payment,
round(1000.0 * number_of_providers
/ nullif(number_of_ffs_beneficiaries, 0), 3) AS providers_per_1k_ffs
FROM public.cms_market_saturation m, latest
WHERE m.aggregation_level = 'NATION + TERRITORIES'
AND m.reference_period = latest.p
ORDER BY providers_per_1k_ffs DESC NULLS LAST;
-- Home Health 8,488 providers · 39,524,879 benes · 0.215 / 1k · $15.97B
-- Durable Medical Equip. 45,963 providers · 39,598,270 benes · 1.161 / 1k · $27.04B
-- Hospice 5,024 providers · 39,475,379 benes · 0.127 / 1k · $15.41B
-- Skilled Nursing Fac. 12,919 providers · 39,391,060 benes · 0.328 / 1k · $27.85B
-- (the per-1k national ranking is led by physician categories — Preventive
-- Health 5.703, Pulmonology 4.556 — which carry hundreds of thousands of
-- billing clinicians; the program-integrity story is the COUNTY clustering
-- of the supplier categories below, not the national physician ratio.)
-- ============================================================================
-- (2) Home health county reconciliation — county presences vs distinct firms.
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
(SELECT number_of_providers::bigint FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'NATION + TERRITORIES' AND reference_period = latest.p
AND type_of_service = 'Home Health') AS national_distinct_agencies,
(SELECT sum(number_of_providers)::bigint FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'COUNTY' AND reference_period = latest.p
AND type_of_service = 'Home Health') AS sum_county_presences
FROM latest;
-- national_distinct_agencies 8,488 · sum_county_presences 23,311
-- (avg agency present in ~2.75 counties; county counts are presences.)
-- ============================================================================
-- (3) HEADLINE: home health counties by agency count (latest period).
-- Los Angeles is the most home-health-saturated large county in the
-- country: 1,847 agencies, 2.12 per 1,000 FFS benes (9.9x national 0.215).
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
county, state, geo_fips,
number_of_providers::bigint AS agencies,
number_of_ffs_beneficiaries::bigint AS ffs_benes,
number_of_users::bigint AS users,
average_users_per_provider AS users_per_agency,
round(1000.0 * number_of_providers
/ nullif(number_of_ffs_beneficiaries, 0), 2) AS agencies_per_1k
FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'COUNTY' AND reference_period = latest.p
AND type_of_service = 'Home Health'
ORDER BY agencies DESC NULLS LAST
LIMIT 8;
-- LOS ANGELES CA 1,847 872,904 72.39 u/agency 2.12 / 1k <- lead
-- COOK IL 365 564,951 0.65 / 1k
-- ORANGE CA 312 308,173 1.01 / 1k
-- DALLAS TX 232 202,655 1.14 / 1k
-- SAN BERNARDINO CA 214 146,380 1.46 / 1k
-- HARRIS TX 201 316,157 0.64 / 1k
-- RIVERSIDE CA 178 200,452 0.89 / 1k
-- MIAMI-DADE FL 172 174,283 0.99 / 1k
-- ============================================================================
-- (4) Home health saturation RATE — top counties with a stable base
-- (>= 20,000 FFS beneficiaries so the ratio is not a small-county artifact).
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
county, state,
number_of_providers::bigint AS agencies,
number_of_ffs_beneficiaries::bigint AS ffs_benes,
round(1000.0 * number_of_providers
/ nullif(number_of_ffs_beneficiaries, 0), 2) AS agencies_per_1k
FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'COUNTY' AND reference_period = latest.p
AND type_of_service = 'Home Health'
AND number_of_ffs_beneficiaries >= 20000
ORDER BY agencies_per_1k DESC NULLS LAST
LIMIT 9;
-- LOS ANGELES CA 2.12 · IMPERIAL CA 1.67 · SAN BERNARDINO CA 1.46
-- GUADALUPE TX 1.40 · CAMERON TX 1.37 · HIDALGO (McAllen) TX 1.31
-- GRAYSON TX 1.28 · VENTURA CA 1.15 · DALLAS TX 1.14
-- (the Texas border counties — Hidalgo, Cameron, Guadalupe — are the
-- classic home health program-integrity corridor alongside Southern California.)
-- ============================================================================
-- (5) State-level home health saturation. California leads at 0.604 per 1,000
-- FFS benes — nearly triple the national 0.215 and the highest of any state.
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
state,
number_of_providers::bigint AS agencies,
number_of_ffs_beneficiaries::bigint AS ffs_benes,
round(1000.0 * number_of_providers
/ nullif(number_of_ffs_beneficiaries, 0), 3) AS agencies_per_1k
FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'STATE' AND reference_period = latest.p
AND type_of_service = 'Home Health'
ORDER BY agencies_per_1k DESC NULLS LAST
LIMIT 8;
-- CA 0.604 · NV 0.517 · DC 0.381 · TX 0.371 · OK 0.336 · LA 0.320 · IL 0.293 · FL 0.282
-- (national 0.215; CA / NV / TX lead.)
-- ============================================================================
-- (6) Durable medical equipment — most-saturated large counties
-- (>= 50,000 FFS benes). National DME rate 1.161 / 1k; these run ~3x it.
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
county, state,
number_of_providers::bigint AS suppliers,
number_of_ffs_beneficiaries::bigint AS ffs_benes,
round(1000.0 * number_of_providers
/ nullif(number_of_ffs_beneficiaries, 0), 2) AS suppliers_per_1k
FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'COUNTY' AND reference_period = latest.p
AND type_of_service = 'Durable Medical Equipment'
AND number_of_ffs_beneficiaries >= 50000
ORDER BY suppliers_per_1k DESC NULLS LAST
LIMIT 10;
-- FORT BEND TX 3.45 · WILL IL 3.43 · MONTGOMERY TX 3.43 · PASCO FL 3.41
-- BALTIMORE CITY MD 3.35 · SUMMIT OH 3.35 · KANE IL 3.35 · HUDSON NJ 3.34
-- CAMDEN NJ 3.33 · DENTON TX 3.32
-- ============================================================================
-- (7) The enrollment-MORATORIUM flag — an honest empty state.
-- CMS retains a moratorium flag on every record. In this snapshot it reads
-- "No" on every row: there is NO active enrollment moratorium anywhere.
-- The 2013-2019 statewide home health / ground ambulance moratoria were all
-- lifted in January 2019, so saturation here is a monitoring signal only.
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT coalesce(moratorium, '<null>') AS moratorium_flag, count(*) AS rows
FROM public.cms_market_saturation m, latest
WHERE reference_period = latest.p
GROUP BY 1
ORDER BY 2 DESC;
-- No 68,044
-- <null> 24
-- (zero rows read "Yes" — in this period or in ANY of the 15 periods;
-- distinct moratorium values across the whole table = {No, NULL}.)
-- ============================================================================
-- (8) Universe reconciliation — period / aggregation-level split.
-- ============================================================================
WITH latest AS (SELECT max(reference_period) AS p FROM public.cms_market_saturation)
SELECT
(SELECT count(*) FROM public.cms_market_saturation) AS all_rows,
(SELECT count(DISTINCT reference_period) FROM public.cms_market_saturation) AS periods,
(SELECT count(DISTINCT type_of_service) FROM public.cms_market_saturation) AS service_types,
(SELECT count(*) FROM public.cms_market_saturation m, latest
WHERE reference_period = latest.p) AS rows_latest,
(SELECT count(DISTINCT geo_fips) FROM public.cms_market_saturation m, latest
WHERE aggregation_level = 'COUNTY' AND reference_period = latest.p) AS counties_latest
FROM latest;
-- all_rows 1,030,290 · periods 15 · service_types 24
-- rows_latest 68,068 · counties_latest 3,141The snapshot
| dataset_id | cms-provider-data-catalog |
| snapshot_date | 2026-06-15 |
| sha256 | |
| doi | 10.5072/fonteum/medicare-market-saturation-2026 |
| slsa_provenance_url |
The JOINs
period: reference_period = max(reference_period) -- latest annual period 2025-01-01..2025-12-31, 68,068 rows
saturation rate = number_of_providers / number_of_ffs_beneficiaries * 1000 -- providers per 1,000 FFS beneficiaries, per row
national baseline: aggregation_level = 'NATION + TERRITORIES' -- home health 0.215 / 1k; DME 1.161 / 1k
county headline: aggregation_level = 'COUNTY', type_of_service = 'Home Health' -- Los Angeles 1,847 agencies, 2.12 / 1k
county counts are presences, not distinct firms (CMS counts a provider per county) -- 23,311 county presences vs 8,488 distinct agencies; compare RATES across geographies
state rollup: aggregation_level = 'STATE', type_of_service = 'Home Health' -- CA 0.604 / 1k, highest state
moratorium flag: distinct(moratorium) over the whole table = {No, NULL} -- zero rows read 'Yes' in any of the 15 periodsThe pipeline version
| git_sha | |
| slsa_provenance | |
| methodology_version | market-saturation/v1 |
Reproduce this
Run the exact query against the frozen 2026-06-15.
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Check the chain
Each figure is snapshot-attested — re-derive the hash from the federal file.
cms-provider-data-catalog · 2026-06-15SHA-256 a3f1c9…7e6b- ACCESS · JUN 2026America's care deserts are rural: two-thirds of U.S. health-care shortage areasTwo-thirds of America's active health-care shortage areas are rural: 13,999 of the 21,133 designated Health Professional Shortage Areas — 66.2% — sit in rural communities, against 6,069 non-rural ones. The rural skew holds across primary care (66.0%), mental health (65.3%), and dental health (67.4%) alike, spanning 25,281 federal designations in 60 jurisdictions.
- ACCESS · APR 2026A March spike in Medicare enrollment deactivations thinned provider supply in shortage areasMedicare enrollment deactivations in PECOS ran 28% above the trailing-twelve-month average in March 2026 — and the spike was not uniform. Deactivations in HRSA-designated shortage areas grew 41% against trend, versus 19% elsewhere. The places least able to absorb a departure lost providers fastest.
- WORKFORCE · JUN 2026Who is enrolled in Medicare? The nurse practitioner is now the most common clinician413,539 nurse practitioner enrollments make NPs the single most common clinician type in Medicare's provider-enrollment file — 13.9% of all 2.98 million PECOS records, nearly triple the largest physician specialty. Together, NPs and physician assistants are one in five enrollments. Advanced-practice providers now anchor the Medicare workforce.
- FINANCIAL DISTRESS · JUN 2026Barred but billable: excluded providers still enrolled in Medicare19 providers barred from all federal health programs by the OIG still hold an active Medicare enrollment record in PECOS — out of 6,880 in-force NPI-identified federal exclusions. Most trace to a single refresh cycle's lag, but two have stood for over a year, one excluded since 2015.
- FINANCIAL DISTRESS · JUN 2026The 5% of prescribers behind half of Medicare's drug billIn 2024 the top 5% of Medicare Part D prescribers — 56,973 of 1.14 million — accounted for 53.5% of the program's $226.7 billion drug bill, while the bottom half split 0.4%. The top 1% alone drove $53.5 billion. The Gini coefficient across prescribers is 0.841.
Federal source citations
Fonteum Research · June 15, 2026 · All figures trace to the frozen federal-data snapshot cited above.