Home Safety: Preventative Care Starts with a Safe Home

Originally published by Evolve

How home modifications are emerging as a powerful solution to rising healthcare and long-term care costs.

Introduction

A Turning Point in Long-Term Services and Supports (LTSS)

As many States aging population continues to grow, the strain on the Medicaid system is becoming untenable. State Medicaid systems faces a perfect storm of rising demand for long-term services and supports (LTSS), a shortage of institutional care options, and mounting costs tied to preventable hospitalizations, emergency department utilization, and premature nursing home placements.

Without proactive, evidence-based interventions, State Medicaid programs are on track for a care and cost crisis that will ultimately impact low-income, aging, and disabled individuals.

Environmental Accessibility Adaptations (Home Modifications), implemented under the CalAIM Community Supports framework, represent one of the most underutilized yet powerful tools to reverse this trajectory. Home Modification interventions directly address environmental barriers that lead to falls, hospitalizations, and functional decline. Yet, despite their effectiveness, they remain underleveraged within many LTSS strategies.

This white paper examines the clinical and financial case for expanding Home Modifications as a core component for all Managed Care and Medicaid programs.

The evidence is clear: targeted home modifications improve outcomes, reduce avoidable healthcare costs, and support state's goals of enabling individuals to age in place gracefully.

The LTSS Challenge

Unsafe Homes Drive Higher Healthcare Costs

With State's LTSS expenditures projected to climb sharply over the next decade, many health plans unknowingly absorb costs driven by home-based risks: falls, injuries, inaccessible bathrooms, and unsafe mobility setups.

The results of an unsafe home are highly measurable:

• Falls are the leading cause of injury-related ED visits and hospitalizations in adults 65+

• 1 in 3 older adults falls annually, costing Medicaid over $50 billion nationally

• A single fall with hip fracture can increase care costs by $30,000-$40,000 per member

Home Modifications bring an underutilized and innovative approach to unsustainable cost and care trends.

Home Modification services are uniquely positioned to disrupt these cost and care trends and deliver a return on investment that is both measurable and mission-aligned for states and their agency partners.

What is a Home Modification?

A Clinical and Preventative Solution

In California, Environmental Accessibility Adaptations are clinically targeted home modifications that make living environments safer and more functional. Examples include:

• Grab bar and handrail installations

• Shower conversions and non-slip flooring

• Stair lifts and widened doorways

• Wheelchair ramps and improved lighting

These are clinical interventions that are both preventative and proven to improve health outcomes. Home Modifications support discharge planning, prevent institutionalization, and promote long-term independence for those living in their communities.

The Evidence

Utilization & Outcomes

Recent data from California Department of Health Care Services (DHCS) and statewide Community Supports providers, including Evolve - reveal powerful results.

These results represent the Home Modification benefit as an innovative approach to:

• Fewer hospitalizations, LTC cost savings and greater stability for members aging in their communities.

For health plans, the implications are profound:

• Fewer downstream costs, more predictable utilization, and better performance on quality measures such as HEDIS and CMS Star Ratings.

For state policymakers, this means Medicaid dollars are being used more efficiently:

• Delivering both short-term relief and long-term systemic savings.

Cost Savings

The cost savings data released by the California Department of Health Care Services (DHCS) provides one of the clearest demonstrations to date that Environmental Accessibility Adaptations (Home Modifications) are not merely supportive services, but high-value clinical interventions.

For health plans and state medicaid agencies, the data validates:

• Clinically targeted home modifications can extend community tenure, reduce reliance on nursing facilities, and support aging-in-place at a fraction of the cost of long-term institutional care.

These outcomes represent cost avoidance across the highest-expense segments of the Medicaid delivery system and demonstrate the powerful role of Home Modifications in bending the cost curve for high-risk, high-need populations.

The 8.7% reduction in PMPM long-term care costs reveals that Home Modifications are a structural solution to prevent premature institutionalization.

The Reach

Evolve's Role in Scaling Impact Across California and other States

As the leading benefit manager of Home Modification services, Evolve has supported thousands of Medicaid members across California and beyond with clinically tailored home safety interventions. Our approach to Home Modification services integrates clinical input, care coordination, and compliance oversight to deliver scalable solutions statewide.

Evolve's clinically driven approach ensures equitable access across rural, urban, and underserved communities. DHCS's data confirms not only the effectiveness of Home Modifications, but the importance of scalability and providing states with the infrastructure needed to expand this complex benefit.

Conclusion

A Call to Action

Environmental Accessibility Adaptations (Home Modifications) ranked among the top 5 most cost-effective Community Supports evaluated. Home Modification interventions offer a practical, evidence-based path to reducing LTSS costs while improving member health and independence.

State's and health plans are all burdened with navigating the intersection of health outcomes, fiscal responsibility, and population well-being. Home Modifications present a rare convergence: an intervention that is preventative, cost-effective, clinically validated, and equity-driven.

We stand at a decision point. Continue with the status quo spending that reacts to decline or shift our investment upstream, using the members living environment to prevent decline in the first place.

The First Rule of Preventative Care starts with a Safe Home

By implementing scalable Home Modifications programs statewide, other states like California can lead in redefining what proactive, equitable aging looks like for all and set the new standard for how Medicaid can deliver true value-based care in the home.

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