Here's another article I thought you would all be interested in, it's a bit
long though.

Beth T the OT

Date: April 15, 2003
For Release:  Immediately

Contact:  HHS Press Office
(202) 690-6343
Robert Wood Johnson Foundation Public Affairs
(609) 627-5937

Headline:  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 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:
http://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.