Designing a Medicare Home Care Benefit: Learning from Experience with Maryland Community First Choice

The project seeks to gather data from the Maryland CFC program to inform understanding of how at-home benefits are being utilized and substituting for other types of care (e.g. patient characteristics, utilization trends, hours of unpaid and paid personal care, etc.). CFC claims data will be analyzed by the Hilltop Institute under contract to JHU. The project team will analyze data from the National Health and Aging Trends Study (NHATS) to set the national context for paid and unpaid personal care of older adults with physical/cognitive impairment by income and Medicaid enrollment.

This project’s report will be comprised of the following: 1) NHATS data brief; 2) a case study of Maryland’s CFC program (e.g. rationale, goals, design, expected effects); 3) data analyses on utilization and cost of personal care services, as well as the extent of substitution of paid services for those previously provided by unpaid caregivers; 4) analysis of implications of Maryland’s CFC experience for a similar benefit under Medicare.

The analysis intends to address major concerns of policy makers with a Medicare at-home care benefit (e.g. supporting continuation of family caregiving and budget accountability), which could be considered under a new Administration and Congress in 2017.