Cash and Counseling

The Center for Health Care Strategies, Inc. summarizes findings from a survey of Medicaid agencies to identify which consumer-directed approaches are being considered and implemented. Findings show growing trends toward consumer direction, agencies initiating policies to reward health-related behaviors and increasingly allocating control of funds to recipients, and states interest in health savings account-like plans and increasingly providing health plan quality data to the public.

States are increasingly interested in the individual budget model for older Medicaid beneficiaries as a mechanism to improve responsiveness of benefits to beneficiaries’ needs and preferences and to increase their ability to remain outside or leave nursing homes. This report describes 10 operating individual budget model programs that serve older persons and identifies four areas of program design that are of particular importance to the success of the individual budget model.

This Issue Brief by the Alliance for Health Reform provides a short overview of the Cash & Counseling program. Sections include How the program came about, Access, health outcomes, and satisfaction with service, Five steps in getting started, Cost comparisons, Outstanding issues, Fast facts and Expert sources.

A new Health Services Research Journal is a dedicated issue to Cash & Counseling. Review the summary of 15 articles; topics include public/private partnerships, research design and methodological issues, evaluation, consumer enrollment and experiences, costs, worker issues and case histories. Also find two commentaries on Cash & Counseling, one on the international context and the other about social experimentation.

This study examines how a new service delivery model of consumer direction affected Medicaid and Medicare service use and costs. Of particular interest were the program's effects on expenditures for the services that the program \"costed-out\" (that is, those services for which an allowance was provided instead) and on total expenditures for all Medicaid services.

Given the complexities of F/EA operations, it is important to refer to reliable source information such as the lists of Government F/EA and Vendor F/EA Tasks. This information will assist state and local program agency staff in understanding the requirements and key elements of Government and Vendor F/EA operations and developing a Government F/EA Policies and Procedures Manual, when applicable.

In light of this major change and assuming that states may want to learn more about Cash & Counseling, this publication offers an in-depth description of the option, a discussion of key findings from the three-state demonstration, and preliminary information about the program’s expansion into 12 more states. At the end is a list of resources—both Web sites and published materials—for further information. Stories about consumers who have first-hand experience appear throughout this publication.

The Consumer-Directed Supports Toolbox is a set of materials developed under the Community-Integrated Personal Assistance Services and Supports (CPASS) grant awarded to North Carolina in 2002. It was developed to support the implementation of consumer-directed options in North Carolina. The “toolbox” consists of 3 powerpoint presentations, a set of exercises to be used in conjunction with the powerpoints, a consumer-directed supports manual, brochures and other visual aids.

In September 2004, Minnesota’s Real Choice Systems Changes grantees presented at the Illinois 2004 Systems Change Seminar. Presentations covered the Minnesota’s Personal Assistance Care Program, QA/QI grant, ADRC grant, and its Senior Health Insurance Program. A variety of topics covered include quality assurance, stakeholder involvement and personal assisted services

A new AAHSA report proposes that individuals and government share the burden of paying for long-term care costs. The final report recommends that the nation move away from Medicaid's welfare model of long-term care financing and adopt an insurance system that is funded by premiums, provides cash benefits so consumers have optimal flexibility in choosing care options, and offers as close to universal coverage as possible. Review the AAHSA Cabinet LTC Financing Strategy.