Medicaid Education and Eligibility Planning for Caregivers: Website Usability and Validation Study.

Abstract

Background: Most older Americans have not saved enough to cover long-term care costs. Medicaid-a public health care program for low-income individuals-can help Americans with qualifying care needs pay for assistance in a nursing home or for services in the home. Determining financial eligibility for Medicaid is complicated, and the application process is often managed by family caregivers with limited knowledge of Medicaid programs.

Objective: A one-stop digital solution is needed to help family caregivers plan for the cost of long-term care services and learn about getting help paying for services through Medicaid. We aimed to develop a web application that (1) educates informal caregivers about Medicaid programs and eligibility criteria, (2) informs them about the cost of home and institutional care in their local area with and without Medicaid coverage, and (3) uses a custom algorithm to provide personalized financial eligibility information based on the care recipient's income, assets, and monthly spending.

Methods: We first interviewed aging services providers and informal family caregivers, then developed a web application that was refined based on user experience interviews with English- and Spanish-speaking caregivers. In the final validation phase, asynchronous usability sessions were recorded with 109 informal caregivers who completed a series of tasks. Participants viewed and rated animated Medicaid "explainer" videos, input financial information to enable the custom algorithm to determine the care recipient's eligibility for Medicaid, adjusted settings on a care cost calculator to estimate the regional cost of home and institutional care services, and completed a Medicaid knowledge quiz before and after using the website.

Results: After engaging with the website and watching the videos, scores on a Medicaid knowledge quiz increased by 61.2% (2-tailed t92=12.9, P<.001). Participants found it easy to enter the care recipient's financial information to determine Medicaid eligibility (out of 7; mean 5.9, SD 1.3) and perceived the care cost calculator as very helpful (out of 7; mean 6.3, SD 1.2). The website received a very high System Usability Scale rating of 88.3 out of 100 (SD 13.1). Caregivers verbalized wanting more education on complex financial concepts that impact Medicaid eligibility and asset preservation.

Conclusions: A comprehensive Medicaid planning website can significantly improve caregivers' knowledge of Medicaid and provide them with a personalized roadmap for accessing care services. The custom algorithm powering the Medicaid eligibility determination could be further refined to account for state-based exceptions. This application may reduce caregiver burden and help support the long-term care planning process.