Association for Public Policy Analysis & Management

Monitoring and billing of home visits by providers to the elderly and disabled who have qualified and been enrolled in a Maryland Medicaid waiver program is done through a system called the In-Home Supports Assurance System (ISAS). We present the technology used by providers to clock into and out of home visits as tracked in ISAS, and discuss its security and performance shortcomings. We conclude that a distributed blockchain based system would not work for the "check in" component of ISAS. This tamper-proof permissioned ledger has the potential to reduce fradulent or improper billing. Evaluation of the system find the current system too fragile for blockchain integration. However, this permissioned ledger system would potentially function well in the "home meal delivery" component of state level services and billing.