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Stuff to know about . . .
"Consumer Direction"
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Do we need a study to tell us it's okay to run our own lives?
Evidently.The idea of "consumer direction" is unnerving to many state Medicaid officials and administrators. A study released in January 1999 found that state administrators by and large distrust programs that give money directly to individuals to hire their own personal assistance.
The study, (also available as a word document - link to download), was conducted by the National Institute on Consumer-Directed Long Term Services and surveyed 257 administrators of state departments of aging, Medicaid, mental retardation/developmental disabilities and vocational rehabilitation in all 50 states to get an idea of what they thought of giving people funds to hire personal assistance workers. Nearly half of the state administrators in the study said they had concerns about "the lack of quality assurance" when people hire their own assistants.
They were also worried about fraud and abuse in the programs; and they felt that running programs that let people hire their own assistants "could be difficult to implement."
Terms and more terms
There are really two "models":
Agency-directed home "health care" services under the "medical model," and
Consumer-directed personal assistance services under the "independent living model."
Agency-directed services:
are delivered through a provider agency by "caregivers" who are supervised by medical "professionals";
Use case management to "coordinate services"
States often want to set laws and regulations to ensure "quality of care" in agency programs. And with good reason -- many agencies have problems with abuse and other issues. (See our page on Safety.
States often give great weigh to the judgement of "professional staff" in these home "health care" agencies. In fact, many state officials distrust the idea of people using state funds to hire their own assistance.
Consumer-directed personal assistance services
is the term used to describe the other approach.
Cash and Counseling is a term for a new "model" that is really just "consumer direction" -- with the added idea of getting "counseling" to help with things like money management. It's a way for the admnistration to confirm by studies what the independent living movement has wanted for years -- control of one's own personal assistance services.
In 1996, four states -- Arkansas, Florida, New Jersey and New York-- were funded by The Robert Wood Johnson Foundation and the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services "to test the idea of giving Medicaid recipients with disabilities the choice of traditional services or cash along with counseling assistance. "
In bureaucratic terms, this is referred to as a "demonstration assessing the use of cash payments directly to people with disabilities."
The University of Maryland Center on Aging was designated to be the national program office responsible for directing and coordinating the demonstration, providing technical assistance to the states, in collaboration with the National Council on the Aging, Inc.
In October, 1998, the four states were granted Medicaid waivers from HCFA to actually carry out the Cash and Counseling with Medicaid dollars.
This four-state effort is an attempt to develop hard data that will satisfy state administrators of Medicaid programs and "prove the value" of giving money directly to individuals to hire their own in-home assistance.
"Individuals can use the cash allowance to meet their personal assistance needs in the way they think best. Those who receive the cash payments will have available to them fiscal intermediary (i.e. bookkeeping and accounting) services and counseling on the hiring, training, and management of personal assistants."
The project's evaluation component is being conducted by Mathematica Policy Research, Inc.
Read an overview of the Cash and Counseling Project at http://www.inform.umd.edu/EdRes/Colleges/HLHP/AGING/CCDemo/NCILmemo.html
Learn more about the Cash and Counseling programs from the University of Maryland Program on Aging.
Overview of Cash and Counseling programs from Consumer Choice News
Freedom Clearinghouse is a project of
Free Hand Press, publisher of Mouth magazine.
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