The National Institute on Aging awarded Duke University $3.272 million under the Aging Research program (CFDA 93.866) on August 5, 2026, to conduct a five-year comparative study examining whether switching Medicaid waiver beneficiaries from paid aides to paid family members for home care increases time at home and reduces publicly funded healthcare costs. The research, conducted in Durham, North Carolina, uses North Carolina Medicaid program data from 2017–2025 to apply causal inference methods comparing person-centered outcomes, potential harms, and public expenditures for adult waiver beneficiaries living with disability who switched provider types. The study addresses a knowledge gap created by a benefit design change that accelerated during the 2020 aide scarcity, when states expanded flexibility to allow self-directed waiver beneficiaries to choose family members as caregivers instead of agency-provided aides. Clinical demonstration evidence suggests payment-induced family care reduces acute care use and inpatient expenditures, but real-world effects on safety-at-home outcomes and state healthcare costs remain undocumented. The research integrates claims, managed care, and program data to descriptively evaluate North Carolina's policy change and its effects on this understudied population. Performance period runs through July 31, 2030.