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Copyright ©2007
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RESEARCH INFORMATION ON INDEPENDENT
LIVING Cash and Counseling Demonstration Evaluations Cash and Counseling discourages
Medicaid from favoring institutions Medicaid is the primary funding source of personal assistance services for individuals with disabilities who have low incomes. Through Medicaid, states can choose to offer personal assistances or not. Most states do through their personal care services (PCS), which only cover attendant care. Or states offer Medicaid’s 1915c home- and community-based services (HCBS) waiver programs that offer more care, services, and products determined by service providers. States typically funnel Medicaid money to licensed care agencies. As an experiment, some state Medicaid programs are trying Cash and Counseling Demonstration Evaluations through special waivers from the Health Care Finances Administration. Cash and Counseling allows people receiving Medicaid benefits to get money directly for buying personal assistance services instead of services through a care agency. The program provides information on assistance service management and requires all to develop a spending plan. Sample programs have been operated in Florida, Arkansas, and New Jersey. Before the Florida state program started, University of Maryland Center on Aging researchers surveyed 378 persons and found of the 100 who answered for themselves, about 44% said they were interested in getting cash to pay for their own assistance services. Of people who answered for the adults getting services, 38% said they thought the service user would be interested in the cash option. Service users’ desire for greater say in selecting services, race, and functioning status linked with service user interest. Both groups wanted to make sure they could back out of the program if they wanted. Findings from the first 200 people using the program in Arkansas and New Jersey revealed 90% of participants in both states used the money to get help with bathing. Nearly 60% of Arkansas participants and 75% of New Jersey participants used cash to for eating assistance. Two-thirds of the Arkansas participants and three-fourths of those in New Jersey stayed with the program at least nine months. Participants used their cash allowances, which averaged about $1,300 a month, to typically hire family members as caregivers. Thirty-three percent hired more than one caregiver. J. Frogue, Health Care Task Force Director, American Legislative Exchange Council, said in a 2003 The Heritage Foundation report that Florida has gone the furthest empowering Cash and Counseling users. It was available in 19 counties, and the Florida legislature voted unanimously to continue it in 2002. “The initial successes of the Cash and Counseling experiments explode the myth that Medicaid beneficiaries are not capable of making their own decisions,” Frogue said. “In fact, it shows just the opposite: They can, they want to, and—once given that chance—do a very good job of it. This is amply demonstrated by satisfaction rates with the program that approach 100%.” The program in all states seems to have proved successful. About four of five program participants in a 2002 Agency for Healthcare Research and Quality study said the program improved their lives. U.S. Health and Human Services figures show that 82% of Arkansas participants reported their lives had improved. Participants indicated they received more services for the same amount of dollars, and hospital, and nursing home costs for participants were 18% less than those for beneficiaries receiving traditional Medicaid services. Another survey of 1,739 participants of the Cash and Counseling project in Arkansas by the Robert Wood Johnson Foundation and the Department of Health and Human Services also turned up high ratings. Of the 2,000 Medicaid users participating in a Cash and Counseling program with an average allowance of $320 a month, more than 90% said they were very satisfied with their paid caregivers. Reports of paid caregivers failing to complete tasks were about 60% lower than the group not in the program. Reports showed Cash and Counseling care was as least as safe as agency care. Research by Mathematic Policy Research Inc. published in June 2003 stated that direct outreach proved more effective than community education in letting people know about the program. It also showed many want help managing benefits, and those who don’t have close relatives or friend had a hard time finding care assistants. Each participating state said it wanted to continue the program.
Information for this review came from the interactive Research Information on Independent Living (RIIL) database at www.GetRiil.org, which contains research summaries related to independent living with disabilities. A special effort has been made to include information that independent leaders in the field said they wanted, namely topics regarding accessible, affordable housing, effective advocacy for rural areas, effective transition from schools and nursing homes, accessible, affordable transportation, reaching underserved populations, policies that impede independent living, rural health care services, and Medicaid/Medicare regulations for durable equipment. RIIL is a joint effort of the Research and Training Center on Independent Living at the University of Kansas and the Independent Living Research Utilization (ILRU) Program of TIRR
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