services they are eligible to receive.
"Medicaid recipients who need help with highly personal things like bathing, toileting, dressing, preparing meals, and housekeeping, want flexibility and a sense of control over how, by whom, and when that help is provided," said Shannon Turner, Deputy Commissioner of the Kentucky Department of Medicaid Services. "The Cash & Counseling program offers that control. It has been shown to improve quality of life as well as access to personal care services. We’re excited that the new Kentucky Cash & Counseling program will enable participants to stay as independent as possible for as long as possible."
The new program, called Kentucky Independence Plus, will be available to all waiver recipients including individuals who are elderly or who have disabilities, those with mental retardation or developmental disabilities and those with acquired brain injuries.
Traditionally, state Medicaid programs have contracted with home care agencies to provide personal care services to the elderly and younger people with disabilities. Although those who are eligible for services may be able to choose among available agencies, frequently their decision-making power ends there. They often have little say in who provides the services or even when or how they are provided.
Cash & Counseling originally was launched in 1995 to give Medicaid beneficiaries choice and control over their personal care needs. It provides a self-directed, individualized budget to recipients of Medicaid personal care services. Participants use the money to hire their own caregivers or purchase items that help them live independently. Each person’s budget is comparable to the value of services that he or she would have received from an agency. Consulting and bookkeeping services are available to help participants weigh their options and keep up with required paperwork. The program is entirely voluntary. If a participant wants to continue receiving personal care services through a Medicaid-contracted agency, that option remains available to them.
"Providing more choice and control to people who are capable of managing these very personal daily activities makes a tremendous difference in improving their quality of life," said Kevin Mahoney, PhD, director of the national office of the Cash & Counseling program and a professor of social work at Boston College. "With 11 new states launching programs, we hope we’re that much closer to the day when every state will make this voluntary option available to Medicaid beneficiaries who have disabilities."
An independent evaluation of the original three-state Cash & Counseling program by Mathematica Policy Research Inc. found that, in all three participating states, when Medicaid beneficiaries of various ages and disabilities were given the opportunity to direct their own supportive services and hire their own caregivers, their quality of life improved, satisfaction with services increased, unmet needs for care were reduced, and access to home care increased without compromising beneficiaries’ health or safety (relative to randomly assigned control groups that received services from agencies).
And while impacts on the use and costs of Medicaid services are not yet available for all three Cash & Counseling programs, results from one (whose evaluation was completed earlier than the others) show that by the second year of enrollment, the consumer-directed option cost no more than agency care, due to lower spending for nursing home and other Medicaid services.
Under the new Cash & Counseling program, 11 states received approximately $250,000 to replicate the program.
The 11 new Cash & Counseling State Programs are:
Alabama Department of Senior Services, $250,000
Iowa Department of Human Services, $250,000
Kentucky Department for Medicaid Services, $250,000
Michigan Department of Community Health, $250,000
Minnesota Department of Human Services, $350,000
New Mexico Aging and Long Term Service Department, $349, 153
Pennsylvania Governor’s Office of Health Care Reform, $250,000
Rhode Island Department of Human Services, $250,000
Vermont Department of Aging and Independent Living, $249,416
Washington Department of Social and Health Services, $250,000
West Virginia Bureau of Senior Services, $250,000
As with the three original demonstration programs, the new round of Cash & Counseling states will need to secure 1915(c) or 1115 waivers from the Centers for Medicare and Medicaid Services (CMS) in order to implement a participant-directed individual budget model for Medicaid.
Betsy Dunnigan, Acting Director, Division of Mental Retardation Services, will direct the Kentucky Cash & Counseling program.
The national Cash & Counseling program is funded by The Robert Wood Johnson Foundation and the Office of the Assistant Secretary for Planning and Evaluation and the Administration on Aging within the U.S. Department of Health and Human Services. The Boston College Graduate School of Social Work will serve as the National Program Office for the new program. In addition, the Centers for Medicaid and Medicare Services will provide technical assistance and oversight related to the states’ demonstration waivers.
The Robert Wood Johnson Foundation, based in Princeton, N.J., is the nation's largest philanthropy devoted exclusively to health and health care. It concentrates its grantmaking in four goal areas: to assure that all Americans have access to quality health care at reasonable cost; to improve the quality of care and support for people with chronic health conditions; to promote healthy communities and lifestyles; and to reduce the personal, social and economic harm caused by substance abuse - tobacco, alcohol and illicit drugs.
More information on Kentucky’s Cash & Counseling program is available by contacting Betsy Dunnigan at