Working against the Clock: Digital Surveillance in US Medicaid Homecare Services

This article explores the implementation of a digital verification system known as Electronic Visit Verification (EVV) across homecare services for older and disabled adults within the US Medicaid program. EVV systems are used to conduct daily check-ins through GPS tracking and biometric identity verification. While touted as a means to identify and deter “fraud, waste, and abuse,” the digital monitoring also generates detailed data trails on the lives and habits of service recipients, as well as constraining their daily movements. Drawing on qualitative interviews with workers and clients, I argue that this case study calls attention to how harms from digitalization of social welfare provision emerge from workplace surveillance and labor management, and how EVV becomes a tool for more finely tuning classifications of different types of paid and unpaid care. The burdensome digital compliance hurdles reinforced older employment tensions between the state, care workers, and public benefits recipients.