State Variation in Smart Device Eligibility for Aging-in-Place Services: Recent Trends in Medicaid Section 1915(c)...

With caregiver workforce shortages on the rise, devices with embedded sensors ("smart devices") hold promise for supporting older adults in community and at-home settings. The purpose of this study was to describe recent trends in coverage related to smart devices in Home and Community-Based Services (HCBS) waivers.

This analysis examined at-home services as outlined in recent Medicaid 1915(c) waivers (January 31, 2020 - May 1, 2026) offered to older adults (age 60 and older) among the 50 states and District of Columbia. Data were obtained from Medicaid waiver applications specific to older adults or including older adult populations with physical disabilities/frailty, using state and CMS repositories. Data elements extracted included waiver text and metadata, assistive technology (AT) categories, and references to smart devices. Descriptive statistics were applied.

Thirty-nine states and D.C. (78.4%) implemented 66 waivers targeting older adults. Three states (MN, OK, and PA) offered the most smart device coverage across AT categories, with smart devices permitted most frequently in the Personal Emergency/Emergency System category (62.1%). While most waivers permit smart devices using broad device eligibility terminology, explicit references for smart devices were identified in 39.4% of waivers across 19 states concentrated in the US Rust Belt, New England, and Atlantic South, including but not limited to motion sensors, smart pens, and GPS trackers.

This study outlines emerging state-by-state variability in Medicaid coverage for smart devices under HCBS waivers. Future research should assess the relationship between state waiver terminology and smart devices that receive coverage across states.