POST-COVID-19 SMART DEVICE SPECIFICATIONS IN U.S. MEDICAID SECTION 1915(C) WAIVER COVERAGE FOR ASSISTIVE TECHNOLOGIES AND MONITORING SERVICES
Author(s)
Stephanie Zawada, PhD, MS1, Michelle Fogus, M.F.A.2, Emily Mills, MPH3, Emma Fortune, PhD4, Laura Cepoi, MA2;
1Mayo Clinic, Kern Center for the Science of Health Care Delivery, Rochester, MN, USA, 2Olympic Area Agency on Aging, Aberdeen, WA, USA, 3Intuition Robotics, Seattle, WA, USA, 4Mayo Clinic, Rochester, MN, USA
1Mayo Clinic, Kern Center for the Science of Health Care Delivery, Rochester, MN, USA, 2Olympic Area Agency on Aging, Aberdeen, WA, USA, 3Intuition Robotics, Seattle, WA, USA, 4Mayo Clinic, Rochester, MN, USA
OBJECTIVES: Medicaid Section 1915(c) Home and Community-Based Services (HCBS) waivers specify assistive technologies (AT) and monitoring services (MS). For older adults, new smart devices can mitigate caregiver workforce shortages, especially in rural regions; however, state-level variations in eligibility criteria can limit access to smart devices. To enhance Medicaid pilot demonstrations with companion robots, we summarize explicit specifications for smart (sensor-based) device coverage in 1915(c) waivers for older adults.
METHODS: Waivers from all states and DC, effective since the end of the COVID-19 Public Health Emergency (May 12, 2023 - January 1, 2026), were compiled from CMS and state websites. Regarding AT and MS provisions, data on eligible smart devices and services were extracted. Only waivers specific to adults aged 60 and older or those including older adults with physical disabilities were included.
RESULTS: Of the 46 eligible waivers, 28.3% (n = 13) described smart devices in AT and MS, representing 10 states: CT, IN, IA, ME, MA, MN, NC, PA, UT, and WI. Six waivers listed motion sensors as eligible while 4 waivers described use cases for GPS sensors (3 for emergencies and 1 for wandering detection). One waiver covered “smart devices” that adjust appliances and utilities while 2 waivers listed “sensors” as eligible without defining use cases.
CONCLUSIONS: Since the Public Health Emergency expired, 10 states included smart devices in their 1915(c) waivers as AT and MS, primarily including motion and GPS sensors. Unlike states whose waivers outline functions of technology, states that define explicit technologies, like those examined in this analysis, may introduce barriers to accessing smart devices driven by narrow device or use specifications. With an ever-growing set of applications for smart devices and tools like companion robots, future research on outdated waiver specifications is critical to ensuring equitable access to cutting-edge tools for older adults, particularly those in rural areas.
METHODS: Waivers from all states and DC, effective since the end of the COVID-19 Public Health Emergency (May 12, 2023 - January 1, 2026), were compiled from CMS and state websites. Regarding AT and MS provisions, data on eligible smart devices and services were extracted. Only waivers specific to adults aged 60 and older or those including older adults with physical disabilities were included.
RESULTS: Of the 46 eligible waivers, 28.3% (n = 13) described smart devices in AT and MS, representing 10 states: CT, IN, IA, ME, MA, MN, NC, PA, UT, and WI. Six waivers listed motion sensors as eligible while 4 waivers described use cases for GPS sensors (3 for emergencies and 1 for wandering detection). One waiver covered “smart devices” that adjust appliances and utilities while 2 waivers listed “sensors” as eligible without defining use cases.
CONCLUSIONS: Since the Public Health Emergency expired, 10 states included smart devices in their 1915(c) waivers as AT and MS, primarily including motion and GPS sensors. Unlike states whose waivers outline functions of technology, states that define explicit technologies, like those examined in this analysis, may introduce barriers to accessing smart devices driven by narrow device or use specifications. With an ever-growing set of applications for smart devices and tools like companion robots, future research on outdated waiver specifications is critical to ensuring equitable access to cutting-edge tools for older adults, particularly those in rural areas.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HPR103
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity, Insurance Systems & National Health Care, Reimbursement & Access Policy
Disease
SDC: Geriatrics