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Medicaid States will now be able to more easily provide Medicaid beneficiaries in need of personal care services with a new "self- directed" personal assistance service option, a private group said Jan. 29. Prior to Jan. 1, any state interested in introducing a so-called Cash & Counseling option was required to obtain a Section 1115 or 1915c waiver from the Centers for Medicare & Medicaid Services, according to an announcement from the Cash & Counseling National Program Office at the Boston College Graduate School of Social Work. However, Section 6087 of the Deficit Reduction Act of 2005, which took effect Jan. 1, now allows states to offer a Cash & Counseling option within their regular Medicaid states plans without first obtaining a waiver. Known as "Cash & Counseling," the program gives beneficiaries eligible for personal care services--frail elderly people and those with disabilities--the option to manage a flexible budget and decide for themselves what mix of goods and services will best meet their care needs. Cash & Counseling was created to help address the serious barriers these individuals can meet when seeking personal assistance through the traditional route, state- contracted home care agencies. Typically, services chosen involve help at home with daily activities such as bathing, dressing, grooming, and meal preparation. Cash & Counseling participants may use their budget to hire their own personal care aides, including family members and friends, as well as buy items or make home modifications that help them live independently. The Cash & Counseling program is jointly funded by the Robert Wood Johnson Foundation and the Department of Health and Human Services. "The new law will make it possible for Cash & Counseling to become an option in more states--giving thousands more elderly adults and people with disabilities choice and control over their Medicaid personal assistance services," said Kevin J. Mahoney, director of the Cash & Counseling National Program Office at Boston College. Mahoney added that the federal waiver process is long, cumbersome, and difficult for states, and the new option will address many of the issues that currently hinder states that want to offer the self-directed option. Evaluation An independent evaluation from Mathematica Policy Research Inc. found that Cash & Counseling programs improve the delivery of personal care services, boost beneficiaries' quality of life, reduce unmet needs for care, and help disabled consumers maintain health without costing more than traditional services, a release from the Boston-based Cash & Counseling organization. According to Mathematica, participants in the three states that implemented the first Cash & Counseling programs, Arkansas, Florida, and New Jersey, were satisfied with the program and a large majority said it significantly improved the quality of their lives. At the same time, the Cash & Counseling participants had fewer unmet care needs and were able to better maintain their health, compared to participants in a control group. The programs also significantly improved the lives of their primary caregivers, Mathematica said. Fraud and abuse concerns with the program proved unfounded, researchers said. The three states also found that Cash & Counseling did not cost substantially more than traditional personal care services provided by state-contracted home health agencies. However, overall costs to Medicaid were somewhat higher for Cash & Counseling participants because the home health agencies failed to deliver approved care to beneficiaries in the control group, Mathematica said. The release said that based on the results, 12 more states are now implementing Cash & Counseling programs: Alabama, Illinois, Iowa, Kentucky, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, Washington, and West Virginia. More information on Cash & Counseling programs.
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