Impact of Electronic Visit Verification (EVV) on Medicaid Personal Care Services Workers

The 21st Century CURES Act, enacted by Congress in 2016, requires that all states implement Electronic Visit Verification (EVV) for Medicaid-funded Personal Care Services (PCS) on January 1, 2019 and for Home Health Care Services (HHCS) by January 1, 2023. EVV electronically verifies that a caregiver provides services for a client.  According to the Centers for Medicare and Medicaid Services (CMS), EVV will improve program efficiencies by validating service delivery and reducing waste, fraud, and inefficiency.

Implementation of EVV has raised concerns for both personal care services (PCS) workers and disabled clients. The law, along with recent CMS sub-regulatory guidance, provides limited detail on the level of specificity required of EVV systems, leaving states latitude to implement their own design.

We will investigate if EVV in selected representative states acts as a barrier, facilitator, or a promising practice related to worker privacy, job satisfaction, and retention. Key deliverables will include: (1) a report summarizing the findings for policy makers, CMS, and state Medicaid programs, and (2) a policy brief.

We will conduct a literature review including both the peer-reviewed and gray literature to learn how EVV implementation thus far serves as barriers or facilitators to worker recruitment and job satisfaction, and community living for disabled people and older adults. We will select four diverse states among those that have rolled out EVV, including two states that have implemented the program for HCCS agencies. Within each of these states, we will identify individual PCS workers, consumer-directed PCS referral agencies, and HCCS agencies. An estimated 10-12 representative workers and 2 PCS and HCCS agency administrators from each state will be invited to answer research questions during 30-45 minute telephone interviews.


Key Questions

  • What are PCS workers and PCS and HCCS agencies’ perspectives on the EVV requirement? Is it a benefit/burden/other? Why?
  • Does the EVV requirement affect workers’ ability to perform their jobs? If so, how?
  • Do workers report that EVV affects their personal privacy?
  • Have workers experienced any technical problems using EVV?
  • How does EVV affect recruitment of new workers and worker retention?
  • From the worker perspective, is EVV affecting client choice and autonomy regarding home and community activities?
  • How could EVV be improved?


Miller, J, Breslin, ML, Chapman, SA. Impact of Electronic Visit Verification (EVV) on Personal Care Services Workers and Consumers in the United States.

For questions, contact: Susan Chapman, PhD, RN, Associate Director, UCSF Health Workforce Research Center on Long-Term Care, [email protected].