Family Member Caregivers for Dual-Eligible Medicare/Medicaid Enrollees

This project examined the use of family members (e.g., spouses, children, siblings, and other relatives) to provide paid long-term care services in home and community-based settings. A handful of states have historically allowed family members to be reimbursed as personal care assistants through Medicaid Home and Community-Based Services (HCBS). The use of paid family members is growing nationally as other states expand their consumer-directed personal care programs. Many of these allow beneficiaries to choose their preferred care providers. Paying for family caregivers helps offset the significant costs and burdens of uncompensated family caregiving, and boosts the potential long-term care workforce. While this creates the possibility of the government paying for something that is often provided for “free,” the potential financial return on investment comes from reducing unnecessary admissions to nursing facilities in those cases where there is a shortage of personal caregivers and family members would not be able to provide the service without receiving a payment to support themselves. If family members can be adequately compensated for providing personal care services, this may increase the number of available personal caregivers and the options for the frail elderly to receive long-term care services outside of institutional settings. What was unknown in this approach is whether paying family members to be personal caregivers actually increases the use of HCBS that offsets nursing home admissions, and the level of payment that makes a difference. The way in which California administers its payment rates for personal caregivers in the Medicaid program creates variation in hourly payment rates across the state’s 58 counties.

This investigation provided a natural experiment to examine these questions. We examined post-discharge utilization of long-term supports and services (LTSS) among dual-eligible Californians who were discharged from an acute inpatient hospital stay from 2006-2008.

For more information, contact [email protected].