Mathematica Policy Research

This report summarizes the results of a telephone survey conducted by Mathematica in mid-2002 of adults age 50 and over in 13 communities. The report includes population characteristics as well as their knowledge of long-term care coverage and service availability.

Medicaid beneficiaries who have disabilities and receive personal care services (PCS) from home care agencies have little control over their care. As a result, some are dissatisfied, have unmet needs, and experience diminished quality of life. This study of Arkansas’s Cash and Counseling demonstration program, IndependentChoices, examines how consumer direction affects these aspects of care quality relative to agency-directed services

The report describes the design & implementation of Arkansas’ model of Cash & Counseling—IndependentChoices—and draws lessons from the state’s experience. The report is based on in-person interviews conducted with Arkansas state officials, IndependentChoices’ program staff, staff providing counseling and fiscal services under IndependentChoices, staff providing traditional PAS in Arkansas, and staff of advocate organizations. The summary also draw lessons for future Cash & Counseling programs.

This report describes the design and implementation of Personal Preference, New Jersey’s model of Cash and Counseling. It also draws lessons from the state’s experience. The report is based primarily on in-person interviews conducted in April 01, about 18 months after the program began enrolling beneficiaries (Nov 99).

Changes in characteristics, insurance status, and health care access were illustrated in this study that analyzed survey data on Social Security Disability Insurance (SSDI) beneficiaries during the six-year window surrounding SSDI entitlement. Findings suggest that there are significant gaps in the safety net for disabled workers before, during, and after the transition to SSDI.

How can person-level data in the Medicaid Analytic eXtract (MAX) data system be used to better understand Medicaid long-term care service use and expenditures? In the analysis, the authors: compare expenditure and utilization-based measures of the balance of institutional and community-based LTC services; examine Medicaid LTC expenditures and utilization for two key groups of enrollees; decompose community-based LTC service expenditures by type of service; and summarize other Medicaid services.

Cash & Counseling provides a flexible monthly allowance (based on the consumer’s care plan or claims history) that consumers can use to hire their choice of workers, including family members, and to purchase other goods & services. A demonstration was implemented in three states-Arkansas, Florida, & New Jersey. Based on their experiences, this paper draws lessons on designing & implementing a Cash & Counseling program, to provide information useful to states thinking of adopting such a program.