Cash and Counseling

This is the official website of the National Resource Center for Participant-Directed Services (NRCPDS), which is the only national center of its kind to assist states and other agencies or organizations that want to offer, or already offer, participant-directed services to people with disabilities. NRCPDS provides technical assistance, research, education, and training to both Medicaid and non-Medicaid funded programs.

The Veterans Directed Home and Community Based Services program, sometimes referred to as Cash and Counseling for Veterans is designed to allow veterans who are potential candidates for nursing home placement to receive that level of care in their homes. The program provides veterans with a budget and allows them to choose their own care providers in place of receiving care services from the VA health care system. To learn more, explore this website.

National policymakers and state Medicaid leaders are paying greater attention to better management of long-term supports and services (LTSS). A combination of factors presents state purchasers with significant opportunities to improve care and control costs by better coordinating and managing the full continuum of long-term care services. In this new publication series, states explore and understand emerging options. Review data and options for transforming long-term-care programs.

In June 2008, Tennessee passed legislation restructuring LTC service delivery, including the expansion of HCBS services by integrating LTC within a managed care environment and providing consumer direction options. In March 2010, the state implemented the CHOICES program, wherein persons enrolled in TennCare that needed LTC services would receive them through a managed care organization. Review a presentation given at the 2010 HCBS conference and the CHOICES website.

Hiring relatives as caregivers remains a controversial policy issue. This two-state case study reports findings about views from policy experts regarding a policy option to hire family caregivers in HCBS long-term care programs. Policy makers also discussed information needed by other states considering this option and effective approaches to disseminate findings about this option from the Cash & Counseling Demonstration Evaluation.

What are the goals of consumer direction? Does mental illness affect consumer direction of community-based care? This presentation addresses these and other tough questions faced in planning and implementing participant-directed programs. Information on consumer assessments, representatives, and common sense approaches and intervention are discussed, as well as additional tools and resources.

What are some of the essential components of Medicaid long-term care programs? This brief, geared towards people working in Medicaid or disability employment, discusses payment for long-term care, range of services, administration, eligibility, functional assessment and rebalancing of long-term care systems. Also find examples of how some states have incorporated aspects of long-term care services and supports (LTSS) into their Medicaid Buy-In (MBI) programs.

Review findings of a study of outcomes of adults with mental illnesses in the Cash & Counseling program compared to those receiving traditional Medicaid services. Such individuals experienced higher satisfaction with their quality of life and with their paid caregivers, fewer unmet needs, no more injuries or other adverse health outcomes than other patients, no significant differences in total expenditures, and were able to successfully manage the cash option.

Explore the use of social marketing principles to enhance enrollment in the C&C Demonstration and Evaluation (CCDE). In this study, focus groups were conducted in Arkansas and Florida. Several lessons emerged from the findings including the importance of conducting process evaluation activities early during program implementation, carefully selecting and training personnel to conduct outreach and enrollment activities, and developing specific messages to include in marketing the cash option.

Review this article addressing family policy questions that are often asked about consumer-directed services. Issues such as quality, suitability, and fraud and abuse are examined. Elder consumers and their caregivers who participated in the Arkansas Cash and Counseling program were interviewed. Analysis of responses demonstrates how this model can address both the needs of consumers with diverse disabilities and policy makers.