Health Affairs

Posting date: November 19, 2003

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Health Affairs, 10.1377/hlthaff.w3.566
Copyright © 2003 by Project HOPE

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The Effects Of Cash And Counseling On Personal Care Services And Medicaid Costs In Arkansas

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

¹ Stacy Dale is a researcher at Mathematica Policy Research in Princeton, New Jersey.
² Randall Brown, is a senior fellow at Mathematica Policy Research in Princeton, New Jersey and the project's director and co-principal investigator.
³ Barbara Phillips is the study's principal investigator; she is an independent consultant in San Diego, California.
⁴ Jennifer Schore is a senior researcher and the deputy project director at Mathematica, in Princeton.
⁵ Barbara Lepidus Carlson is a senior sampling statistician and survey director at Mathematica, in Princeton.

^*Corresponding author.

Abstract

The Cash and Counseling Demonstration gives Medicaid beneficiaries who are eligible for personal care services a consumer-directed allowance in lieu of traditional agency services. Using survey and Medicaid claims data on 2,008 adult applicants randomly assigned to treatment or control groups, we find the program increased the receipt of paid care but reduced unpaid care. The treatment group had higher Medicaid personal care expenditures than controls did, because many controls received no paid help, and recipients obtained only two-thirds of entitled services. By the second year after enrollment, these higher personal care expenditures were offset by lower spending for nursing homes and other Medicaid services.

Key Words: Access To Care, Chronic Care, Consumer Issues, Home Care, Insurance Coverage, Medicaid, Medicare

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