Background and Purpose The American Stroke Association recommends post-stroke rehabilitation for those who qualify and have access to this service. Continued services at the post-hospital residential and outpatient rehabilitation levels of care result in further functional gains after acquired brain injury, including stroke, even when provided beyond 6-12 months post onset. Access to care remains a barrier to rehabilitation including third-party limits with funding and coverage restrictions. This study measured outcomes comparing those with state legislated Compulsory Funding (CF) vs. Restricted Funding (RF) for post-hospital neurorehabilitation. Methods There were a total of 402 participants across 14 states included in the study. The CF group had 201 and the RF group had 201 participants. The Mayo-Portland Adaptability Inventory (MPAI-4) was selected as the primary dependent measure. Results Post-hospital rehabilitation length of stay (LOS) was significantly shorter in the CF group, t(400) = 1.72, p < 0.05 (Cohen's d = 0.17). A Mixed 2x2 RM-MANCOVA revealed a significant main effect of time of testing, Pillai's Trace f(1,398) = 402.6, p < 0.001; power to detect = 0.99, partial eta2 = 0.50. The analysis also revealed significant between groups main effect f(1,398) = 12.8, p< 0.001, power to detect = 0.94, partial eta2 = 0.031. The results of Bonferroni post-hoc pairwise comparisons are presented. Conclusions This study examined the differences in rehabilitation outcomes and LOS for persons receiving CF post-acute neurorehabilitation with individuals receiving services in other states with RF. While both groups improved, the state legislated access to care CF group started post-hospital neurorehabilitation without delay, discharged more quickly thereby reducing cost, with a lower level of disability (MPAI-4 Indices) at discharge compared to the RF group.

The authors have declared no competing interest.

No external funding was received.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

NeuroRestorative IRB #1 (U.S. Department of Health and Human Services, IRB #: IORG0011535). Approved through June 30, 2025

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