Medicare beneficiaries may be admitted to home health following an inpatient stay (post-acute) or directly from the community (community-entry). An analysis of Medicare data for rural, fee-for-service Medicare beneficiaries who utilized home health from 2011 to 2013 found significantly higher rates of community-entry among beneficiaries who were older, female, non-white, living alone, and dually eligible for Medicare and Medicaid, and who had lower clinical severity, lower functional status, more cognitive impairment, and a higher need for caregiver assistance for supervision and safety. Wide variation by state also exists in rates of community-entry home health for rural beneficiaries. Results suggest two different populations are being served by the Medicare home health benefit, which supports differentiation between community-entry and post-acute episodes in payment policy reform.