title: Consumer enrollment and experiences in the Cash and Counseling program.
abstract: Consumer direction of Medicaid supportive services raises concerns about who should be permitted to self-direct, whether consumers should be allowed to pay family members, whether a self-directed option increases demand for services, and how to ensure quality. The Cash and Counseling programs contained features designed to address these concerns. DEMONSTRATION ENROLLMENT: Many consumers used representatives to manage the allowance on their behalf and others chose to disenroll, suggesting that beneficiaries were capable of deciding for themselves whether the programs were suitable for them. Participation among eligible beneficiaries during the demonstration was modest, suggesting that consumer direction did not itself substantially increase the demand for services. CONSUMER EXPERIENCES: Most consumers were able to assume the role of employer without difficulty, many hiring relatives or acquaintances as workers. In each state, more than 85 percent reported they would recommend the program to others seeking more control over their care, and more than half said the program had "improved their lives a great deal."
authors.affiliation: Mathematica Policy Research Inc., PO Box 2393, Princeton, NJ 08543, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Schore
authors.forename: Leslie
authors.initials: L
authors.lastname: Foster
authors.forename: Barbara
authors.initials: B
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019090:Case Management / Q000458:organization & administration; D002648:Child; D003258:Consumer Behavior; D006233:Persons with Disabilities; 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; D008875:Middle Aged; D010358:Patient Participation; D014481:United States; D014483:United States Dept. of Health and Human Services / Q000458:organization & administration