Medicaid ‘Cash and Counseling’ Demonstration Beneficiaries Satisfied with Services, Preliminary Study Reports
Last week, Mathematica Policy Research, Inc. released early findings from its study of Cash and Counseling, an "innovative" method of delivering services to frail elderly and disabled Medicaid beneficiaries. The Medicaid demonstration program, currently being tested in Arkansas, Florida and New Jersey, provides a monthly cash allowance to participating Medicaid beneficiaries to purchase in-home personal assistant services, rather than obtaining them through a home care agency as under the traditional Medicaid program. A "unique" feature of the demonstration is that consumers also can use the funds to purchase needed goods or items, such as specialized "equipment" for meal preparation. The goal of the program is to improve consumers' ability to control personal care services and satisfaction with such services without increasing Medicaid costs. Participants also receive counseling on how to spend the cash allowance. In the issue brief, Mathematica researchers evaluated the 200-member Arkansas demonstration, called the Arkansas Independent Choices program, in which about 75% of enrollees program were age 65 and older, more than half were in poor health and a majority suffered from chronic illnesses. Study findings include the following:
- A majority of enrollees were "highly pleased" with their care arrangements. Ninety-five percent were "pleased" with the times of day they could obtain assistance from hired caregivers.
- All enrollees (100%) were satisfied with their caregiver relationship. This finding, Mathematica notes, is "very different from traditional care arrangements, under which consumers are sometimes unhappy with the way agency workers treat them."
- No participants said they were "worse off than before," and 93% would recommend the program to others.
- Enrollees "almost always" hired caregivers they were already close to personally, with more than 75% choosing a family member and 15% choosing a friend, neighbor or church member to provide care for an average of 10 to 20 hours a week. Forty percent of enrollees hired multiple caregivers to meet their needs.
- In addition to hiring caregivers, enrollees used their allowance to purchase items such as equipment for personal activities, communication or safety, supplies for meals preparation or housekeeping chores or medicine. Researchers expressed "surprise" at the purchase of medicine, and hypothesized it could be related to the "limited drug coverage through the Arkansas Medicaid Program."
- While 80% of Independent Choices participants said they were "satisfied with their lives," 25% to 40% reported they were still not receiving enough help with certain activities, such as meals and housework. Study authors cite this as an example of why there "continues to be room for improvement" (Mathematica Brief, 12/2000).