April 15, 2003
HHS Study Finds Better Results in Self-Directed Care
Today, the Department of Health and Human
Services (HHS) announced the initial findings of the Medicaid Cash and
Counseling demonstration project underway in Arkansas. Below . . . is a copy of
the HHS press release detailing the success of the program. The initial findings
show what many of us already know -- self-directed care succeeds at protecting
recipients' health and safety AND enhances consumer satisfaction. Today's study,
carried out by Mathematica Policy Research, Princeton, N.J., is available at:
www.healthaffairs.org/WebExclusives/Foster_Web_Excl_032603.htm.
- Troy Justesen, Associate Director for the White
House Office Of Domestic Policy
Nfi@Whitehouse.Gov
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NEWS RELEASE
Robert Wood Johnson Foundation
U.S. Department of Health & Human Services
FOR IMMEDIATE RELEASE
Tuesday, April 15, 2003
Contact: HHS Press Office
(202) 690-6343
RWJ Public Affairs
(609) 627-5937
MEDICAID RECIPIENTS WITH DISABILITIES BENEFIT FROM DIRECTING THEIR OWN
PERSONAL CARE SERVICES, STUDY FINDS
Medicaid recipients with disabilities who direct their own supportive services
were significantly more satisfied and appeared to get better care than those
receiving services through home care agencies, according to initial findings of
a demonstration project jointly supported by HHS and the Robert Wood Johnson
Foundation. With self- direction, the recipients' satisfaction and quality of
life were improved substantially and unmet needs for care were reduced, without
compromising health or safety, the study found.
The initial findings, from an ongoing evaluation of the Cash and Counseling
demonstration project, were released in a web exclusive edition of the Journal
of Health Affairs. In the project, participants are given an allowance and a
high degree of flexibility and freedom to choose personal care assistants. The
first phase of the evaluation examined whether this self-directed care succeeded
at protecting recipients' health and safety in addition to enhancing their
satisfaction. The study looked at both elderly and non-elderly adult Medicaid
recipients with disabilities who receive Medicaid-supported home services.
"This approach gives people with disabilities more freedom and responsibility,
in the same way that all of us want to be in charge of our lives and our
choices," said HHS Secretary Tommy G. Thompson. "It lets the individuals
themselves decide how best to use the Medicaid dollars they are already entitled
to. The study confirms that these Medicaid recipients make good choices that
maintain their health and safety, even as they improve their convenience,
satisfaction and quality of life."
"The Cash and Counseling program offers Medicaid consumers flexibility and a
sense of control over their care," said Risa Lavizzo-Mourey, M.D., M.B.A.,
president and CEO of the Robert Wood Johnson Foundation. "We're encouraged that
these initial findings indicate that giving patients this kind of greater
autonomy over their choices for care can enhance the quality of their lives.
This program is an important part of the Robert Wood Johnson Foundation's
longstanding mission to improve the quality of care for people with chronic
conditions."
The Cash and Counseling demonstration project is being tried in Arkansas, New
Jersey and Florida. The study announced today contains findings from the
Arkansas demonstration, which was the first to be implemented. The demonstration
examines delivery of personal care services like bathing, grooming and meal
preparation. Most states provide some coverage for such services in their
Medicaid programs, in part to help maintain individuals in their homes rather
than in nursing facilities or other institutional settings. In most cases, these
supportive services are provided by home care agencies.
The Cash and Counseling Demonstration was designed to compare outcomes of
traditional agency-directed care with care that is directed by the recipient --
especially to determine whether satisfaction increased and health and safety
were maintained. Under the Cash and Counseling approach, the recipient (or
designee) is provided with a monthly allowance, equivalent to what would be
spent under traditional Medicaid for the care authorized, and a high degree of
freedom in using the allowance. For example, recipients may use their allowances
to hire friends and family members (excluding spouses) as caregivers. They may
also use the monthly allowance to purchase assistive equipment or
home-modifications related to their personal care needs. Counseling is provided
to help recipients develop a spending plan for the allowance.
Medicaid beneficiaries who receive supportive services from agencies "often have
little control over who provides their care, when they receive it, or how it is
delivered. For some, this lack of control over basic, often intimate, assistance
leads to dissatisfaction, unmet needs and diminished quality of life," says the
report. At the same time, the report notes, "some stakeholders fear that
eliminating agency involvement jeopardizes consumer health and safety."
The study announced today compared randomly selected, voluntary participants
using the Cash and Counseling approach with a control group of those who had to
rely on traditional agencies. Findings include:
- Satisfaction with caregivers was much higher for those in Cash and Counseling.
Reports of paid caregivers failing to complete tasks were about 60 percent lower
than the control group.
- The Cash and Counseling group was much less likely to report unmet needs for
assistance of several types. For example, the proportion of non-elderly
consumers not receiving desired help with transportation was about 40 percent
lower than for the control group rate.
- Care for those in the Cash and Counseling approach was at least as safe as
agency-directed care, as reflected in reports of disability-related adverse
events, health problems and general health status.
- Program participants were nearly 20 percentage points more likely than the
control group to express satisfaction with their lives, among both elderly and
non-elderly consumers.
"States are increasingly interested in using consumer- directed approaches for
this kind of supportive care," said Kevin Mahoney, director of the
demonstration's national project office at the University of Maryland Center on
Aging, which oversees the project. "But before expanding these programs, the
states want to be sure this approach is safe as well as satisfying for patients.
The Cash and Counseling Demonstration is answering those questions."
Future reports will deal with other aspects of the Arkansas program, as well as
the demonstrations in New Jersey and Florida. Altogether, some 1.2 million
Medicaid recipients nationwide get supportive services.
"Approaches like this hold great promise for making Medicaid more cost-effective
and serving people with disabilities better," said Tom Scully, administrator of
HHS' Centers for Medicare and Medicaid Services (CMS). "These approaches are
especially important in light of the President's New Freedom Initiative, in
which he has directed government to do more to help people with disabilities to
live at home and avoid institutionalization."
Recent actions by HHS have made it easier for states to adopt consumer-directed
approaches for Medicaid recipients with disabilities. "Independence Plus" waiver
templates, introduced by HHS last year, enable states to obtain the needed
permission to operate such programs with a minimum of HHS review. Funds provided
under the Real Choice Systems grants also help support states in planning such
programs.
In addition, President Bush has proposed changes in the Medicaid program that
would give states much more flexibility. Under the proposal, states would be
able to implement programs of this kind without needing to obtain HHS
permission.
The Cash and Counseling programs in each of the three states are funded by the
Robert Wood Johnson Foundation. The evaluation is funded jointly by the
foundation and HHS Office of Planning and Evaluation.
Today's study, carried out by Mathematica Policy Research, Princeton, N.J., is
available at:
www.healthaffairs.org/WebExclusives/Foster_Web_Excl_032603.htm.
More information on the Cash and Counseling demonstration program is available
at www.umd.edu/aging.
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