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Experiences of Workers Hired Under Cash and Counseling: Findings from Arkansas, Florida, and New Jersey
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Author(s): Stacy Dale, Randall Brown, Barbara Phillips and Barbara Carlson |
Organization(s): Mathematica Policy Research |
Assessing the well-being of workers hired under consumer direction and addressing their concerns is critical, because the consumer-directed model is sustainable only if workers are satisfied with it. While caer recipients who manage their own care appear to be much more satisfied than consumers who receive agency care, the primary reason given for dropping out of a consumer-directed option is difficulty finding or keeping a worker. Moreover, turning to consumer direction and tapping consumers' family members and friends as additional sources of labor could help solve the serious worker shortage. In this report, the authors use results from all three states participating in the Cash and Counseling demonstration--Arkansas, Florida and New Jersey--to assess the experiences of workers hired under consumer direction. [62 PDF pages] |
Published: August, 2005 |
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Assessing the Appeal of the Cash and Counseling Demonstration in Arkansas, Florida and New Jersey
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Author(s): Leslie Foster, Randall Brown and Rachel Shapiro |
Organization(s): Mathematica Policy Research |
This report assesses the appeal of the Cash and Counseling demonstration by: (1) estimating the proportions of eligible beneficiaries that participated and comparing the characteristics of participants and nonparticipants; (2) describing beneficiaries' most common reasons for agreeing or declining to participate; and (3) examining whether the demonstration affected the number of beneficiaries accessing personal care services or home and community-based services over time. [56 PDF pages] |
Published: July, 2005 |
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Consumer and Consultant Experiences in the New Jersey Personal Preference Program
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Author(s): Leslie Foster, Barbara Phillips and Jennifer Schore |
Organization(s): Mathematica Policy Research |
The report describes the implementation of Personal Preference by synthesizing information from in-person discussions with program staff, a mail survey of program consultants, telephone interviews with consumers in the treatment group, and program records. It discusses the program's goals and features, the ways consumers managed their program responsibilities and took advantage of increased flexibility, and the degree to which consumers were satisfied with the program. [95 PDF pages] |
Published: July, 2005 |
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How Cash and Counseling Affects Informal Caregivers: Findings from Arkansas, Florida and New Jersey
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Author(s): Leslie Foster, Randall Brown, Barbara Phillips and Barbara Lepidus Carlson |
Organization(s): Mathematica Policy Research |
This report describes the effects of Cash and Counseling on the caregivers who were providing the most unpaid assistance to adult beneficiaries when those beneficiaries volunteered to participate in the demonstration and completed a baseline telephone interveiw. The caregivers in this analysis--identified by beneficiaries as their primary informal caregiver at baseline--were interviewed about 10 months later. This report follows earlier findings that beneficiaries who were randomly assigned to participate in a Cash and Counseling program were more satisfied with their supportive services than were beneficiaries who were assigned to rely on personal care services or home and community-based services as usual. [69 PDF pages] |
Published: July, 2005 |
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Consumer and Consultant Experiences in the Florida Consumer Directed Care Program
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Author(s): Leslie Foster, Barbara Phillips and Jennifer Schore |
Organization(s): Mathematica Policy Research |
This report describes the implementation of consumer directed care by synthesizing information from in-person discussions with program staff, a mail survey of program consultants, telephone interviews with consumers in the treatment group, and program records. It discusses the programs goals and features, the ways beneficiaries managed their program responsibilities and took advantage of increased flexibility, and the degree to which beneficiaries were satisfied with the program. (Other reports from the evaluation estimate the programs impacts on beneficiaries, their caregivers, and public costs; describe the types of beneficiaries and workers who chose to participate in the demonstrations; and explain demonstration implementation and program operations in greater detail.) [100 PDF pages] |
Published: June, 2005 |
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Effect of Consumer Direction on Adults' Personal Care and Well-Being in Arkansas, New Jersey, and Florida
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Author(s): Barbara Lepidus Carlson, Stacy Dale, Leslie Foster, Randall Brown, Barbara Phillips and Jennifer Schore |
Organization(s): Mathematica Policy Research |
This report examines the effects of the Cash and Counseling program in three states--Arkansas, Florida, and New Jersey--regarding how consumer direction affects the use and quality of both paid and unpaid personal care assistance received by consumers, as measured by consumers' satisfaction with care, the frequency of unmet needs, and the incidence of adverse health events arising from inadequate care. More than half the evaluation sample is elderly or cognitively impaired, and thus the success of the program for these consumers should help to address worries about offering consumer-directed care to this population. [88 PDF pages] |
Published: May, 2005 |
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The Effect of Cash and Counseling on Medicaid and Medicare Costs: Findings for Adults in Three States
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Author(s): Stacy Dale and Randall Brown |
Organization(s): Mathematica Policy Research |
Recent research suggests that Floridas Cash and Counseling model-Consumer Directed Care (CDC)-increased the well-being of children with disabilities and their parents in Florida and that the Cash and Counseling programs in Arkansas, Florida, and New Jersey similarly increased the well-being of adults. The program also increased the likelihood that consumers in all three states would receive paid personal care services. However, the results to date on costs are less clear-cut. Arkansass Cash and Counseling program increased personal care costs for adults, but, because of savings on other Medicaid services, the higher costs were partially offset during the first postenrollment year and almost fully offset during the second. Floridas program for children increased Section 1915(c) waiver costs, although savings on home health services partly offset the higher costs. This report compares results from all three demonstration programs to examine how consumer direction for adults affects Medicaid and Medicare service use and costs. [96 PDF pages] |
Published: May, 2005 |
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The Effects of Cash and Counseling on the Primary Informal Caregivers of Children with Developmental Disabilities
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Author(s): Leslie Foster, Randall Brown, Barbara Phillips and Barbara Lepidus Carlson |
Organization(s): Mathematica Policy Research |
This report describes the effects of Floridas Cash and Counseling demonstration program, Consumer Directed Care (CDC), on the caregivers who were providing the most unpaid assistance to children when their parents voluntarily enrolled those children in the demonstration. This report follows another one containing earlier findings, which showed that the parents of children randomly assigned to participate in the CDC program were more satisfied with the childrens care than were the parents of children randomly assigned to receive traditional home and community-based services. [45 PDF pages] |
Published: April, 2005 |
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Medicaid Costs Under Consumer Direction for Florida Children with Developmental Disabilities
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Author(s): Stacy Dale, Randall Brown and Barbara Phillips |
Organization(s): Mathematica Policy Research |
The randomized design of the evaluation of the national Cash and Counseling Demonstration enables researchers to rigorously analyze costs under traditional and consumer-directed approaches. In this report, we use results from Floridas Consumer Directed Care for children to investigate the programs effect on Medicaid waiver costs, other Medicaid costs, and Medicaid service use under consumer-directed and traditional programs for the two-year period after demonstration enrollment. [38 PDF pages] |
Published: December, 2004 |
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Do Consumer-Directed Medicaid Supportive Services Work for Children with Developmental Disabilities?
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Author(s): Leslie Foster, Stacy Dale, Randall Brown, Barbara Phillips, Jennifer Schore and Barbara Lepidus Carlson |
Organization(s): Mathematica Policy Research |
The evaluation of Cash and Counseling is the first to use a randomized design to compare service use and quality under traditional versus consumer-directed approaches to Medicaid supportive services. As part of the evaluation, this paper presents results for the children and parents who participated in Floridas Cash and Counseling demonstration program, Consumer Directed Care. [78 PDF pages] |
Published: September, 2004 |
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