Assoc. Prof. Kevin Mahoney (GSSW), program director of Cash and Counseling.
In its demonstration period, Cash and Counseling showed that when Medicaid beneficiaries of various ages and disabilities have the option to direct their own supportive services, their quality of life is improved, satisfaction with services is increased, unmet needs for care are reduced, access to home care is increased and nursing home usage is reduced - without compromising the beneficiaries' health or safety. Further, the option costs Medicaid no more than traditional agency services.
The Cash and Counseling program provides self-directed, individualized budgets to recipients of Medicaid personal care services or home and community-based services. Each person's allocation is comparable to the value of services that he or she would have received through a traditional agency.
Program participants use the allocation to purchase their own care - with the option of hiring friends, family members, or others - instead of receiving it from an agency. They can also use their budgets to modify their homes or vehicles or to purchase a range of items - from chair lifts to touch lamps - that will help them live independently. Consulting and bookkeeping services are available to help participants weigh their options and keep up with required paperwork.
Under the new, expanded Cash and Counseling program - for which GSSW will serve as the national office - as many as 10 states will receive up to $250,000 each over three years to replicate the consumer-directed model. Three of these states may receive up to $100,000 each in additional funds to expand the model.
"The Cash and Counseling model is an idea whose time has come," said Assoc. Prof. Kevin Mahoney (GSSW), program director of Cash and Counseling and of a new BC-based national social work research center dedicated to improving the quality of support and services for the elderly and disabled [see separate story].
"The demonstration program showed this idea works. Now we want to take it to a national level."
Traditionally, state Medicaid programs have contracted with home care agencies to provide personal assistance services - such as bathing, dressing, grooming, preparing meals, and housekeeping - to the elderly and younger persons with disabilities. Although those who are eligible for services may be able to choose among available agencies, frequently their decision-making power ends there. They often have little say in who provides the services or even when or how they are provided.
"For example, most home care aides come only during the day, and only during the week," Mahoney said. "Those who receive the care, therefore, only get it when it's available, not when they actually need it. That means someone requiring assistance to get out of bed and prepare meals, for example, may have to wait until later in the day to rise and eat. And what happens on weekends, if the aide doesn't work then?
"The 'one-size-fits-all' philosophy in elderly and disabled care services just doesn't work," he said. "People with age-related or other disabilities face enough of a challenge every day. At the very least, they should be able to choose the help they want and need to perform the tasks of everyday life."
In launching this effort, the Robert Wood Johnson Foundation is joined by two funding partners: the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Administration on Aging (AOA) within the US Department of Health and Human Services. In addition, the Centers for Medicare and Medicaid Services will help provide oversight and technical assistance to states.
An evaluation of Cash and Counseling published in two parts by the journal Health Affairs can be viewed on-line at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w3.162v1 and http://content.healthaffairs.org/cgi/content/abstract/hlthaff.w3.566.
More information about the program is available at the Cash and Counseling World Wide Web site, www.cashandcounseling.org, or the Robert Wood Johnson Foundation site, www.rwjf.org.
-Office of Public Affairs staff
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