State Variation in Smart Device Eligibility for Aging-in-Place Services: Recent Trends in Medicaid Section 1915(c) Waiver Coverage for Older Adults

Purpose

With caregiver workforce shortages on the rise, devices with embedded sensors ("smart devices") hold promise for supporting older adults in community and at-home settings. The purpose of this study was to describe recent trends in coverage related to smart devices in Home and Community-Based Services (HCBS) waivers. Patients and methods: This analysis examined at-home services as outlined in recent Medicaid 1915(c) waivers (January 31, 2020 - May 1, 2026) offered to older adults (age 60 and older) among the 50 states and District of Columbia. Data were obtained from Medicaid waiver applications specific to older adults or including older adult populations with physical disabilities/frailty, using state and CMS repositories. Data elements extracted included waiver text and metadata, assistive technology (AT) categories, and references to smart devices. Descriptive statistics were applied.