{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T03:21:44Z","timestamp":1762917704356,"version":"3.45.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"11","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>As people age, many require help with personal care\u2014often provided by family members or friends or direct care workers. Over the last three decades, driven by the disability rights movement, direct care worker shortages, and caregiver burden, self-direction has emerged as a Medicaid option that allows individuals to hire and pay their own caregivers, including family members.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We use 2021 TMSIS Medicaid claims data linked to Medicare Master Beneficiary Summary File to identify dually eligible beneficiaries 65+ receiving personal care. We describe the demographic characteristics of self-direction users compared to non-self-direction users and present the percentage of self-direction users across states.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We find that over half of dually eligible beneficiaries 65+ receiving personal care use self-direction. Compared to individuals who use agency-based personal care, self-direction users have higher prevalence of chronic disease, higher home health use, and higher Medicare costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Self-direction has become a common model of personal care among older adults enrolled in Medicaid. Examining how funds allocated for self-direction are spent; the effects of self-direction on consumers and their caregivers; and how self-direction may impact Medicare and Medicaid costs is critical to inform the expansion and funding of Medicaid self-direction programs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/haschl\/qxaf192","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T13:47:20Z","timestamp":1760449640000},"source":"Crossref","is-referenced-by-count":0,"title":["Paying family caregivers: self-direction in medicaid personal care"],"prefix":"10.1093","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-6332-6611","authenticated-orcid":false,"given":"Yiqing","family":"Kuang","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6726-2369","authenticated-orcid":false,"given":"Katherine E M","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD 21205 ,","place":["USA"]},{"name":"VA Partnered Evidence-Based Policy Resource Center, Boston VA Health Care System , Boston, MA 02130 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,10,15]]},"reference":[{"issue":"32","key":"2025111122120005700_qxaf192-B1","doi-asserted-by":"publisher","first-page":"882","DOI":"10.15585\/mmwr.mm6732a3","article-title":"Prevalence of disabilities and health care access by disability status and type among adults\u2014United States, 2016","volume":"67","author":"Okoro","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"author":"Centers for Disease Control and Prevention","key":"2025111122120005700_qxaf192-B2"},{"author":"Brown","key":"2025111122120005700_qxaf192-B3"},{"issue":"Pt 2","key":"2025111122120005700_qxaf192-B4","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1111\/j.1475-6773.2006.00673.x","article-title":"Effects of cash and counseling on personal care and well-being","volume":"42","author":"Carlson","year":"2007","journal-title":"Health Serv Res"},{"key":"2025111122120005700_qxaf192-B5","doi-asserted-by":"publisher","first-page":"W3-162","DOI":"10.1377\/hlthaff.w3.162","article-title":"Improving the quality of Medicaid personal assistance through consumer direction","volume":"Suppl Web Exclusives","author":"Foster","year":"2003","journal-title":"Health Aff (Millwood)"},{"issue":"1","key":"2025111122120005700_qxaf192-B6","first-page":"25","article-title":"Cash and counseling demonstration and evaluation. Start-up activities","volume":"6","author":"Mahoney","year":"1997","journal-title":"J Case Manag"},{"issue":"3","key":"2025111122120005700_qxaf192-B7","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1111\/j.1475-6773.2004.00249.x","article-title":"Determining personal care consumers\u2019 preferences for a consumer-directed cash and counseling option: survey results from Arkansas, Florida, New Jersey, and New York elders and adults with physical disabilities","volume":"39","author":"Mahoney","year":"2004","journal-title":"Health Serv Res"},{"key":"2025111122120005700_qxaf192-B8","article-title":"The effect of cash and counseling on Medicaid and Medicare costs: findings for adults in three states.","author":"Dale","year":"2005","journal-title":"Mathematica Policy Research Reports"},{"key":"2025111122120005700_qxaf192-B9","doi-asserted-by":"publisher","first-page":"W3-566","DOI":"10.1377\/hlthaff.w3.566","article-title":"The effects of cash and counseling on personal care services and Medicaid costs in Arkansas","volume":"Suppl Web Exclusives","author":"Dale","year":"2003","journal-title":"Health Aff (Millwood)"},{"issue":"5","key":"2025111122120005700_qxaf192-B10","doi-asserted-by":"publisher","first-page":"678","DOI":"10.1002\/hec.3873","article-title":"What is the marginal benefit of payment-induced family care? 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Systematic documentation of state variation in Medicaid home- and community-based services: the Medicaid home and community-based services dataset initiative. 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