Does Switching to Consumer-Directed Personal Care Impact Health and Service Utilization Among Medicaid Enrollees in the New York Metropolitan Area?

Objectives New York has seen increasing utilization of consumer-directed care, whereby recipients of Medicaid-funded personal care hire, train, and supervise their own caregivers. This study evaluates how switching from agency-based to consumer-directed care impacts health, functional, and social outcomes among care recipients. Design Retrospective cohort study. Setting and Participants: Enrollees in a large health plan in the New York Metropolitan area who received Medicaid-funded personal care. Methods Linked 2017–2022 administrative and clinical assessment data were examined for 10,479 health plan enrollees initially receiving agency-based care, of whom 844 (8%) switched to consumer direction during the observation period. Propensity score matching and doubly robust multivariable regression models were used to examine the impact of switching on 5 outcomes: all-cause hospitalization, falls, any decline in social activities, emergency department visits, and functional decline (impairment in activities of daily living). Results After matching, groups were well-balanced on most baseline covariates. Switching to consumer direction was associated with significantly lower odds of hospitalization (OR, 0.45; P < .001), a lower odds of falls (OR, 0.69; P = .032), and a lower odds of decline in social activities (OR, 0.61; P = .006). Switching was also associated with less functional decline (β, −0.09; P < .001). Conclusions and Implications For those who chose to do so, switching to consumer-directed care was associated with a range of positive outcomes. Reconfiguring older adults’ care convoys to include trusted, consistent caregivers may enhance health monitoring and social well-being. Policies that create administrative barriers to choosing consumer-directed care models should be evaluated for their potential to produce unintended health consequences.