Cash and Counseling: Part of the Long-Term Care Answer?

July 29, 2005

“Cash and Counseling” is a way of allowing individuals receiving personal assistance services through Medicaid to have more control over the services they get and who provides them. The program provides an individualized allowance that beneficiaries can use to hire a personal care assistant of their choice – often a family caregiver – or purchase items that help them live independently, such as chair lifts.

Jointly funded by The Robert Wood Johnson Foundation and HHS, the first phase of the cash and counseling program enrolled beneficiaries with a wide range of disabilities and varying needs for services in three states: Arkansas, Florida and New Jersey. States also provide access to fiscal agents to help beneficiaries plan and manage their monthly allowance (the “counseling” part of the program).

Beneficiary satisfaction with the program has been high, while family caregivers report less stress.The program is now being expanded to 12 additional states.

As policymakers look to the future, what are the lessons learned from the first phase of the cash and counseling program? What are the advantages of this model? Are there potential pitfalls to be avoided? For example, does the program effectively control costs? Are there differences between cash and counseling and traditional Medicaid in consumer satisfaction, quality of life, and the amount and types of personal assistant services obtained?

To help address these and related questions, the Alliance for Health Reform and The Robert Wood Johnson Foundation sponsored a July 29 luncheon briefing. Speakers were: Michael O’Grady, HHS assistant secretary for planning and evaluation; Kevin Mahoney, national program director for the Cash and Counseling program, and William Ditto of the New Jersey Dept. of Human Services’ division of disability services. James Knickman, vice president of The Robert Wood Johnson Foundation, made opening remarks, and Ed Howard of the Alliance moderated the discussion. Randall Brown, vice president and director of health research at Mathematica, was available during the question-and-answer period.


Full Transcript (Adobe Acrobat PDF)

Speaker Presentations

William Ditto Presentation (Adobe Acrobat PDF)
Michael O’Grady Presentation (Adobe Acrobat PDF)
Kevin Mahoney Presentation (Adobe Acrobat PDF)

Event Resources