title: Improving the quality of Medicaid personal assistance through consumer direction.
abstract: As states seek to improve home and community-based services for people with disabilities, many are incorporating consumer-directed supportive services into their Medicaid programs. The national Cash and Counseling Demonstration uses a randomized design to compare an innovative model of consumer direction with the traditional agency-directed approach. This paper presents findings from the first demonstration program to be implemented, in Arkansas. Our survey of 1,739 elderly and nonelderly adults showed that relative to agency-directed services, Cash and Counseling greatly improved satisfaction and reduced most unmet needs. Moreover, contrary to some concerns, it did not adversely affect participants' health and safety.
authors.affiliation: Mathematica Policy Research, Princeton, New Jersey, USA.
authors.forename: Leslie
authors.initials: L
authors.lastname: Foster
authors.forename: Randall
authors.initials: R
authors.lastname: Brown
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schore
authors.forename: Barbara Lepidus
authors.initials: BL
authors.lastname: Carlson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001131:Arkansas; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000523:psychology*; D019538:Health Care Surveys; D006704:Homemaker Services / Q000191:economics / Q000592:standards*; D006801:Humans; D008484:Medicaid / Q000592:standards*; D008875:Middle Aged; D010548:Personal Health Services / Q000191:economics / Q000592:standards*; D010865:Pilot Projects; D011785:Quality Assurance, Health Care; D014481:United States