DOI: 10.3886/e233681v1
title: “Less time committed to care” Beliefs About Electronic Visit Verification Among Adults Using Home-Based Personal Assistance Services

description: In 2016, the federal government mandated that all Medicaid-funded personal assistance services be documented through an Electronic Visit Verification (EVV) program by January 2020. Most states have asked for extensions due to difficulties in implementation and strong opposition from consumer advocacy groups. Qualitative research has documented various concerns of consumers and consumer advocates. In 2020 (prepandemic), we conducted a mail survey of consumers which included questions regarding familiarity with, and attitudes toward, EVV. Respondents could also write in qualitative comments. This paper explores consumers' perceptions of EVV using four survey items related to fraud, benefits, concerns, and protection and 25 qualitative comments related to these topics. We found that respondents agreed most with statements focused on both concerns with EVV interfering with their care and help in reducing fraud. In general, the most common quantitative response to the statements was indifference. Qualitative comments centered on concerns about EVV interfering with services in a variety of ways, although there were also comments related to EVV being protective, beneficial, or helpful in reducing fraud. We also identified a new category in the qualitative comments about consumers' beliefs that the work done by their personal assistance service workers is underrecognized. We recommend that policy makers and service organizations continue to collect information from consumers as EVV is implemented and altered to both meet the expectations of the legislation and the needs of consumers and workers.
description: <b>Demographic Variables:</b><br>1. Age:<br>Constructed as a continuous variable from the respondents' reported age.<br>2. Gender:<br>Constructed as a categorical variable (e.g., male, female, other).<br>3. Race/Ethnicity:<br>Constructed as categorical variables (e.g., White, Black or African American, Hispanic or Latino, etc.).<br>4. Education Level:<br>Constructed as a categorical variable (e.g., high school or less, some college, bachelor’s degree, etc.).<br>5. Employment Status:<br>Constructed as a categorical variable (e.g., employed, unemployed).<br>6. Household Income:<br>Constructed as an ordinal variable based on income ranges (e.g., below $20,000, $20,000-$39,999, etc.).<br>7. Receipt of Social Security Benefits:<br>Constructed as a binary variable (e.g., yes, no).<br><br><b>Attitude Toward EVV:</b><br>1. EVV Interference Concerns:<br>Constructed from the Likert-scale item measuring concern that EVV interferes with the consumer-caregiver relationship.<br>2. EVV as Fraud Prevention:<br>Constructed from the Likert-scale item measuring belief that EVV will reduce fraud in home care services.<br>3. EVV as Protective Measure:<br>Constructed from the Likert-scale item measuring belief that EVV will protect consumers and caregivers.<br>4. EVV Benefits:<br>Constructed from the Likert-scale item measuring belief that EVV will be beneficial overall.<br> <br><b>Qualitative Themes (Coded Variables)</b><b>:</b><br>1. Consumer-Caregiver Relationship Impact:<br>Constructed from open-ended responses highlighting concerns that EVV might negatively impact the relationship between consumers and caregivers.<br>2. Hiring Difficulties Due to EVV:<br>Constructed from comments indicating that EVV complicates the process of hiring caregivers.<br>3. Limitations on Caregiver Time and Services:<br>Constructed from responses pointing out that EVV might limit the time caregivers can spend or the services they can provide.<br>4. Consumer Choice and Control Issues:<br>Constructed from comments that EVV reduces consumer autonomy, particularly in self-directed care models.<br>5. Logistical and Technical Challenges:<br>Constructed from responses mentioning difficulties with the technology and logistics of implementing EVV.<br>6. Unrecognized Unpaid Work:<br>Constructed from comments indicating that EVV does not account for unpaid work performed by caregivers.
description: Presence of Common Scales: Likert scale (1-5) for evaluating agreement with statements about EVV.
description: 1,200 randomly sampled PAS recipients. Stratified random sampling was used, with a focus on ensuring sufficient representation from both metro and nonmetro (rural) areas.
description: The population of interest includes adults with disabilities who receive Medicaid-funded personal assistance services (PAS) and reside in the United States, specifically in Alaska, Arizona, Montana, Texas, and Wisconsin.. Smallest Geographic Unit: Zip codes, categorized into metro and nonmetro areas based on Rural-Urban Continuum Codes (RUCCs).
description: mail questionnaire;