Consumer-Directed Personal Care in the New York Metropolitan Area: Trends in Use From 2017 to 2022

Abstract

Objectives

Despite growing interest in expansion of consumer- (or self-) directed models of Medicaid-funded personal care, research characterizing program use is limited. We leverage health plan and claims data from a large health plan in New York to examine (1) trends in use of consumer-directed care and (2) the impact of the COVID-19 pandemic on consumer-directed care use.

Design

Retrospective cohort study.

Setting and Participants

All individuals enrolled in a large, New York health plan who received Medicaid-funded personal care between January 2017 and December 2022 (n = 47,216).

Methods

Proportion of enrollees receiving consumer-directed care during each month and year was calculated for all enrollees and the subgroups of new and existing enrollees. An interrupted time series model was estimated to examine time trends and impact of the COVID-19 pandemic onset on trends.

Results

Between 2017 and 2022, the proportion of enrollees receiving consumer-directed care increased from 10.3% to 47.9%. Sociodemographic characteristics and average personal care hours remained stable. Models identified a 6% yearly increase in the proportion of enrollees using consumer-directed care pre-pandemic, (P < .001) an immediate 4% bump in use in March 2020 at the onset of the COVID-19 pandemic (P = .001), and an 8% yearly increase in use post pandemic onset (P = .01). Although trends among existing enrollees mirrored overall trends, new enrollees had larger increases in consumer-directed care use early in the study period, which leveled off after March 2020.

Conclusions and Implications

While there was a statistically significant and sustained increase in the proportion of enrollees receiving consumer-directed care at onset of the COVID-19 pandemic, the magnitude of this increase was small in comparison with overall program growth between 2017 and 2022. Additional work to understand how other factors contribute to enrollees choosing consumer-directed care is needed to ensure all Medicaid-funded personal care recipients can have their needs met in the community.