The public/private partnership behind the Cash and Counseling Demonstration and Evaluation: its origins, challenges, and unresolved issues.
OBJECTIVE
To discuss why and how the Cash and Counseling Demonstration came to be designed, implemented, and evaluated through a partnership between the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Robert Wood Johnson Foundation (RWJF).


RESULTS
This public/private partnership was created by two colleagues who were motivated by the need for funding to conduct a large-scale demonstration and evaluation, the prestige that both organizations brought to the project, the ability to draw on both organizations' experience and expertise, and the potential to maximize flexibility in the design and implementation of the demonstration. The partnership, which has lasted over a decade and has supported two generations of Cash and Counseling programs, overcame several challenges including getting approval for the project through their respective bureaucracies, managing the decision making process and the ongoing program across the two organizations, dealing with leadership and staff turnover, and reaching consensus on how to apportion credit for the success of the program. Several unresolved issues remain, including how the program gets operationalized within each state, how case management is addressed within the context of a consumer-directed model like Cash and Counseling, how quality is assured in this type of program, and how the Internal Revenue Service views and treats Cash and Counseling and other consumer-directed programs.


CONCLUSIONS
This public/private partnership is an illustration of how public dollars can be leveraged effectively to examine a pressing policy issue and to produce information that can be translated into better policy and practice. The ASPE/RWJF collaboration made it possible to develop, test, and expand a policy-oriented demonstration project that has become a pivotal strategy in most states' efforts to build their home and community-based service systems.
Knickman
James R
JR
New York State Health Foundation, 555 Eighth Avenue, 24th Floor, New York, NY 10018, USA.
Stone
Robyn I
RI
D019090:Case Management / Q000458:organization & administration; D005376:Financial Management / Q000458:organization & administration; D005582:Foundations / Q000458:organization & administration*; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D008134:Long-Term Care / Q000458:organization & administration; D008484:Medicaid / Q000458:organization & administration; D010358:Patient Participation; D017149:Private Sector; D016730:Program Development; D014481:United States; D014483:United States Dept. of Health and Human Services / Q000458:organization & administration*