Health Affairs

Posting date: March 26, 2003

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Health Affairs, 10.1377/hlthaff.w3.162
Copyright © 2003 by Project HOPE

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Improving The Quality Of Medicaid Personal Assistance Through Consumer direction

Leslie Foster ^1*, Randall Brown ², Barbara Phillips ³, Jennifer Schore ⁴, Barbara Lepidus Carlson ⁵

¹ Leslie Foster is a research analyst at Mathematica Policy Research in Princeton, New Jersey.
² Randall Brown is a senior fellow at Mathematica Policy Research, Princeton, New Jersey.
³ Barbara Phillips is a principal investigator at Mathematica Policy Research in Princeton, New Jersey and a consultant in San Diego, California.
⁴ Jennifer Schore is a senior researcher and the deputy project director at Mathematica Policy Research in Princeton, New Jersey.
⁵ Barbara Lepidus Carlson is a senior sampling statistician and the study's survey director at Mathematica Policy Research, Princeton, New Jersey.

^*Corresponding author.

Abstract

As states seek to improve home and community-based services for people with disabilities, many are incorporating consumer-directed supportive services into their Medicaid programs. The national Cash and Counseling Demonstration uses a randomized design to compare an innovative model of consumer direction with the traditional agency- directed approach. This paper presents findings from the first demonstration program to be implemented, in Arkansas. Our survey of 1,739 elderly and nonelderly adults showed that relative to agency-directed services, Cash and Counseling greatly improved satisfaction and reduced most unmet needs. Moreover, contrary to some concerns, it did not adversely affect participants' health and safety.

Key Words: Chronic Care, Home Care, Medicaid, Rural Health Care

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