Challenges With Accessing Home Care Among Medicaid Beneficiaries

Area of Science:

• Gerontology
• Health Services Research
• Public Health Policy

Background:

• Older adults with chronic conditions often need formal home care to age in place.
• Accessing these services can be difficult and expensive, even with insurance coverage.

Purpose of the Study:

• To evaluate the availability and accessibility of home care services for Medicaid recipients in New York State.
• To identify barriers faced by individuals seeking formal home care.

Main Methods:

• A cross-sectional, secret shopper study involving telephone calls to licensed home care service agencies (LHCSAs) in New York.
• Trained investigators posed as caregivers seeking services for a hypothetical elderly patient with Medicaid.

Main Results:

• Only 51.1% of contacted LHCSAs accepted Medicaid, and 44.4% had wait times over one week for eligibility evaluations.
• Estimating covered care hours was difficult for most agencies; supplemental private pay averaged $33.35/hour.
• Key themes included process complexity, insufficient hours, workforce shortages, and high out-of-pocket costs.

Conclusions:

• Obtaining home care for Medicaid recipients in New York is a complex process with significant access barriers.
• Long wait times, unpredictable coverage, staffing issues, and high supplemental costs impede equitable access.
• Streamlining processes, increasing transparency, and supporting the workforce are crucial for improving home care access.