Medicaid Recipients Like Program That Lets Them Direct Care

Disabled recipients of Medicaid home care services are much happier under an experimental program that lets them hire the helpers themselves, a new study reported in the Boston Globe concludes.

About 1.2 million disabled Medicaid beneficiaries receive supportive services in their homes. But care recipients often report that they have little control over who provides their care, when they receive it, and how it is delivered.

Under an experimental program now running in three states, patients receive a monthly allowance equivalent to the amount that would have been spent under traditional Medicaid for authorized care. The beneficiaries can hire whomever they want to serve as caregivers, including friends and family. The program, called ''''Cash and Counseling,'''' is currently operating in Arkansas, Florida and New Jersey.

Researchers at Mathematica Inc. recently examined consumer satisfaction in the Arkansas program, where participants receive an average of $320 per month to hire helpers, buy supplies or assistive devices, or modify their homes.

The researchers found that people in the experimental program were ''''much less likely'''' than the traditional group to report that paid caregivers performed poorly, and more likely to say that they performed ''''exceptionally well.''''

''''Apparently, [participants] find that having intimate care, such as help with bathing and dressing, performed by a person of one''s own choosing is much more satisfying that having it performed by a stranger,'''' according to the authors of the study, which is available on the Web site of the journal Health Affairs.

Moreover, the results showed that, contrary to some concerns, the Cash and Counseling program did not adversely affect participants' health and safety.

Just over 70 percent of the 1,739 survey respondents were age 65 and older.

The Bush administration would like to see such programs spread further. Several other states have programs allowing consumers to direct home care services themselves.

To read the full article in the Boston Globe, click here. (Article may be only temporarily available.)

To read the study in Health Affairs, click here.