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Model Program that Improves Quality of Life for Elderly Medicaid Beneficiaries and Those with Disabilities Expands to 11 New States

Evaluation of Original Three-State Cash & Counseling Program Found Participants Much More Satisfied with Services Received When They Direct Their Own Care. Expanded Program will Give Thousands More the Opportunity to Exercise Choice and Control Over the Supportive Services They Receive

BOSTON (October 7, 2004) '“ Funders of the original three-state Cash & Counseling program announced today that 11 new states will receive three-year grants of approximately $250,000 each to replicate and expand the successful program, which allows people eligible to receive supportive services through Medicaid to direct their own care and live more independently. The program is funded by The Robert Wood Johnson Foundation (RWJF) and the Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Administration on Aging (AOA) within the U.S. Department of Health and Human Services (HHS).

An independent evaluation of the original Cash & Counseling program by Mathematica Policy Research Inc. found that, in all three participating states, when Medicaid beneficiaries of various ages and disabilities were given the opportunity to direct their own supportive services and hire their own caregivers, their quality of life improved, satisfaction with services increased, unmet needs for care were reduced, and access to home care increased ¾ without compromising beneficiaries'™ health or safety (relative to randomly assigned control groups that received services from agencies).

And while impacts on the use and costs of Medicaid services are not yet available for all three Cash & Counseling programs, results from one (whose evaluation was completed earlier than the others) show that by the second year of enrollment, the consumer-directed option cost no more than agency care, due to lower spending for nursing home and other Medicaid services.

'œWe'™re thrilled to be able to expand this program to 11 new states because it was so obviously a winner for participants in Arkansas, Florida, and New Jersey,' said Risa Lavizzo-Mourey, MD, MBA, president and CEO of RWJF.

'œThis is wonderful news for elderly and younger people with disabilities,' said HHS Secretary Tommy G. Thompson. 'œThis successful model program will allow caregivers and beneficiaries to live independently and with the freedom they desire.'

Under the new Cash & Counseling program, 11 states received approximately $250,000 to replicate the program, and two of those states received an additional $100,000 to expand the model.

The 11 new Cash & Counseling State Programs are:

Alabama Department of Senior Services, $250,000
Iowa Department of Human Services, $250,000
Kentucky Department for Medicaid Services, $250,000
Michigan Department of Community Health, $250,000
Minnesota Department of Human Services, $350,000
New Mexico Aging and Long Term Service Department, $349, 153
Pennsylvania Governor'™s Office of Health Care Reform, $250,000
Rhode Island Department of Human Services, $250,000
Vermont Department of Aging and Independent Living, $249,416
Washington Department of Social and Health Services, $250,000
West Virginia Bureau of Senior Services, $250,000

Traditionally, state Medicaid programs have contracted with home care agencies to provide personal assistance services ¾ such as bathing, dressing, grooming, preparing meals, and housekeeping ¾ to the elderly and younger people 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.

The experimental Cash & Counseling program was launched in 1995 to give Medicaid beneficiaries choice and control over their personal care needs. It provides a self-directed, individualized budget to recipients of Medicaid personal care services. Participants use the money to hire their own caregivers or purchase items ¾ such as chair lifts or touch lamps ¾ that help them live independently. Each person'™s budget is comparable to the value of services that he or she would have received from an agency. Consulting and bookkeeping services are available to help participants weigh their options and keep up with required paperwork.

'œProviding more choice and control to people who are capable of managing these very personal daily activities makes a tremendous difference in improving their quality of life,' said Kevin Mahoney, PhD, director of the Cash & Counseling program and a professor of social work at Boston College. 'œWith 11 new states launching programs, we hope we'™re that much closer to the day when every state will make this voluntary option available to Medicaid beneficiaries who have disabilities.'

Unlike the three original demonstration programs, the new round of Cash & Counseling programs will not include control groups. Grantee states will need to secure 1915(c) or 1115 waivers from the Centers for Medicare and Medicaid Services (CMS) in order to implement a participant-directed individual budget model for Medicaid.

The Boston College Graduate School of Social Work will serve as the National Program Office for the new program. The program is sponsored jointly by RWJF, ASPE, and the AOA. In addition, CMS reviews states'™ Section 1115 demonstration or 1915 (c) waiver applications and provides continuing oversight and technical assistance in the waiver process.

More information on Cash & Counseling is available online at www.cashandcounseling.org or through RWJF'™s Website at www.rwjf.org.