Consumer enrollment and experiences in the Cash and Counseling program

Area of Science:

• Health Services Research
• Social Policy
• Disability Studies

Background:

• Medicaid supportive services face challenges regarding consumer control, family caregiver payments, service demand, and quality assurance.
• The Cash and Counseling demonstration programs were designed to address these specific concerns within consumer-directed care models.

Purpose of the Study:

• To evaluate the effectiveness and consumer experience of the Cash and Counseling demonstration programs.
• To assess beneficiary capacity in self-direction decisions and the impact on service demand.
• To understand how consumers managed the employer role and their overall satisfaction with increased care control.

Main Methods:

• Analysis of demonstration enrollment data to assess beneficiary decision-making regarding program suitability.
• Examination of participation rates to determine the effect of consumer direction on service demand.
• Collection of consumer feedback on their experiences with managing services and their satisfaction levels.

Main Results:

• Beneficiaries demonstrated capability in deciding program suitability, with some using representatives and others opting out.
• Modest participation rates indicated that consumer direction did not significantly increase overall demand for services.
• Over 85% of participants would recommend the programs, with over half reporting significant life improvements due to enhanced care control.

Conclusions:

• The Cash and Counseling programs successfully enabled consumers to direct their Medicaid supportive services.
• Beneficiary experiences suggest high satisfaction and a positive impact on quality of life, with manageable challenges in assuming employer roles.
• The programs demonstrate a viable model for enhancing autonomy and control in long-term care services.