Many disabled people across the country might feel like they are being watched these days. In my home state of Massachusetts, MassHealth has recently introduced EVV (Electronic Visit Verification) for consumers of the PCA (Personal Care Assistant) program. EVV is designed to eliminate waste, fraud, and abuse in the Medicaid system by requiring caregivers of disabled people to “prove” that their client is receiving the care they are entitled to.
Under federal law, all states must require people who provide certain home and community-based services to use some type of electronic visit verification. Noncompliance means their Medicaid programs risk being underfunded.
EVV applications vary by state. For example, some states use smartphone apps that require those who provide home and community-based services to submit images of the disabled person to whom they are providing care on a regular basis.
Sometimes the images must go through a facial recognition process to ensure that the person receiving care is who the provider says they are. An employee’s ability to be paid is contingent on properly taking, uploading, and validating these images. Unless someone qualifies for an exemption, EVV policies must be followed.
In other states, EVV includes a GPS tracking feature. The caregiver’s location is recorded at some point during the visit, either continuously, or at the beginning and end of a shift. Melissa Harville, of Greenbrier, AR says that she utilized the EVV app to determine the distance she can go without triggering a “unauthorized location” alert. The alert must be authenticated before she can be paid. “The metal building down there, we know we can go that far, and to the end of the driveway”. Harville told The Guardian in 2021.
Before the agency Harvile works for began using AuthentiCare in 2020, she and her partner, Kevin Hoover led an active lifestyle. They went grocery shopping, visited friends and family, and went fishing. However, they are limited in where they can go now, because of AuthentiCare. They have to be home so that Harvile can clock in and out at the right time.
EVV vendors claim that their products will save states money by reducing fraud and waste. According to a 2016 federal report, EVV use across the country would result in $290 million in cost savings over a ten-year period, due in part to reduced erroneous billing.
However, there is little evidence that fraud is common or serious. In 2020, only seven people were charged with fraud in self-directed personal care services in Arkansas, out of a workforce of over 4,500, according to data compiled by Applied Self-Direction, a Boston-based company. The state counted three convictions, totaling between $643 -$1,930 per instance. As of 2021, the EVV system had cost the state $5.7 million.
EVV is an invasion of privacy for disabled people. Preventing fraud shouldn’t mean that disabled people are treated like criminals. EVV could lead to disabled people being further isolated from their communities.
Sources:
Aboulafia, Ariana, and Henry Claypool. The Vast Surveillance Network That Traps Thousands of Disabled Medicaid Recipients. Slate Magazine, Graham Holdings Company, 26 July 2023, slate.com/technology/2023/07/ada-anniversary-disability-electronic-visit-verification.html.
“About EVV.” Tempus Unlimited, Tempus Unlimited, 7 Feb. 2024, tempusunlimited.org/about-evv/.
Eubanks , Virginia, and Alexandra Mateescu. “We Don’t Deserve This’: New App Places US Caregivers under Digital Surveillance.” The Guardian, Guardian News and Media, 28 July 2021, http://www.theguardian.com/us-news/2021/jul/28/digital-surveillance-caregivers-artificial-intelligence.
Oduro, Serena, et al. Electronic Visit Verification: A Guide to Intersecting Harms and Policy Consequences. Data & Society Research Institute, 16 Nov. 2021.
Scalia, Kendra. “Electronic Visit Verification (EVV) Is Here.” Disability Visibility Project, Disability Visibility Project, 15 Apr. 2019, disabilityvisibilityproject.com/2019/03/24/electronic-visit-verification-evv-is-here/.