Address correspondence to Pamela Doty, Ph.D., U.S. Department of Health and Human Services, Office of the Secretary, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging and Long-Term Care Policy, 200 Independence Avenue SW, Room 424E, Washington, DC 20201. Kevin J. Mahoney, Ph.D., is with the Boston College Graduate School of Social Work, Chestnut Hill, MA. Lori Simon-Rusinowitz, Ph.D., is with the Department of Health Services Administration, Center on Aging, University of Maryland, College Park, MD.
Designing the Cash and Counseling Demonstration and Evaluation
Article first published online: 3 JAN 2007
Health Services Research
Volume 42, Issue 1p2, pages 378–396, February 2007
How to Cite
Doty, P., Mahoney, K. J. and Simon-Rusinowitz, L. (2007), Designing the Cash and Counseling Demonstration and Evaluation. Health Services Research, 42: 378–396. doi: 10.1111/j.1475-6773.2006.00678.x
- Issue published online: 3 JAN 2007
- Article first published online: 3 JAN 2007
- Consumer direction;
- Medicaid home and community-based services;
- personal assistance services
Objective. The Cash and Counseling Demonstration and Evaluation (CCDE) was designed as an experiment in shifting the paradigm in home and community-based long-term care from a professional/bureaucratic model of service delivery to one emphasizing consumer choice and control. The experimental intervention was an individualized budget offered in lieu of traditional Medicaid-covered services, such as agency-delivered aide services or a plan of care developed and coordinated by a professional case-manager, which typically involves authorization for several different providers to deliver a range of services. Within the spending limits established by their budgets, program participants were largely free to choose the types and amounts of paid services and supports they judged best able to meet their disability-related personal assistance needs.
Study Population. Medicaid beneficiaries in selected states who volunteered to participate. In all of the participating state Medicaid programs, beneficiaries eligible to participate included elders and younger adults with chronic disabilities and, in one state, adults and children with mental retardation/developmental disabilities could also participate. Minor children and adults with cognitive impairment could participate via representatives (family or friends who agreed to assist them in managing their services or to act as their surrogate decision-makers).
Data Sources. Members of the CCDE management team describe the rationale for and implications of key design decisions.
Study Design. Key design decisions included the choice of research methodology (random assignment of CCDE participants in each state to treatment and control groups), selection of the state sites (AR, FL, NJ, NY), and the need for the CCDE to comply with federal waiver requirements for Medicaid research and demonstration projects.
Principle Findings. The CCDE design was successfully implemented in three of the four state Medicaid programs selected for participation.
Conclusions. The successful implementation of the CCDE (results from the evaluation are reported elsewhere) led to replication efforts in other states. The CCDE also inspired changes in Medicaid law and policy, including the 2002 “Independence Plus” Initiative by the Centers for Medicare and Medicaid and sections of the Deficit Reduction Act of 2005 intended to promote consumer-direction in Medicaid.