To respond to Medicaid beneficiaries’ with disabilities long-standing desire to direct their own care by studying whether consumer-directed personal assistance would result in higher quality care and reduce unmet needs without increasing public costs.
Policy-makers responded to Medicaid beneficiaries’ desire to control their own personal care, instead of receiving agency-directed care. They funded research to explore whether consumer-directed services for these beneficiaries-- who were frail or had disabilities—could be high quality, safe and cost-effective.
U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation
The Robert Wood Johnson Foundation
University of Maryland
According to surveys of participants, caregivers, and workers, the program reduced participants’ unmet needs, and improved their satisfaction with care and quality of life. Family caregivers of program participants experienced much higher quality of life and lower levels of physical, emotional, and financial stress than control group caregivers. Workers hired under the program fared well relative to agency workers, reporting higher levels of satisfaction and similar rates of work-related injuries or stress. Finally, administrative claims data showed that program participants had higher costs for personal care (because they were more likely to receive services) but lower costs for other long-term care services. Based on the dramatic positive impacts, the program inspired policymakers to make changes intended to improve the lives of thousands of Medicaid beneficiaries and their caregivers. The federal government passed legislation encouraging consumer-directed care, and twelve more states adopting Cash and Counseling into their Medicaid programs.
Evidence & Insights From This Project
Cash and Counseling: Improving the Lives of Medicaid Beneficiaries Who Need Personal Care or Home- and Community-Based Services
To address the needs of Medicaid beneficiaries who are elderly or disabled and desire greater control over their personal care, the federal government has encouraged states to offer consumer-directed options.Learn More
Experiences of Workers Hired Under Cash and Counseling: Findings from Arkansas, Florida, and New Jersey
Assessing the Appeal of the Cash and Counseling Demonstration in Arkansas, Florida, and New Jersey
How Cash and Counseling Affects Informal Caregivers: Findings from Arkansas, Florida, and New Jersey
Effect of Consumer Direction on Adults' Personal Care and Well-Being in Arkansas, New Jersey, and Florida
The Effect of Cash and Counseling on Medicaid and Medicare Costs: Findings for Adults in Three States
The Effects of Cash and Counseling on the Primary Informal Caregivers of Children with Developmental Disabilities
Do Consumer-Directed Medicaid Supportive Services Work for Children with Developmental Disabilities?
Changing to Consumer-Directed Care: The Implementation of the Cash and Counseling Demonstration in Florida
Easing the Burden of Caregiving: The Impact of Consumer Direction on Primary Informal Caregivers in Arkansas
Lessons from the Implementation of Cash and Counseling in Arkansas, Florida, and New Jersey
Enabling Personal Preference: The Implementation of the Cash and Counseling Demonstration in New Jersey
Cash and Counseling: Consumers' Early Experiences in New Jersey Part II: Uses of Cash and Satisfaction at Nine Months
Moving to Independent Choices: The Implementation of the Cash and Counseling Demonstration in Arkansas
Cash and Counseling Consumers' Early Experiences in Florida Part II: Uses of Cash and Satisfaction at Nine Months
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