Do we need a study to tell us it's okay to run our own lives?
idea of "consumer direction" is unnerving to many state Medicaid officials
and administrators. A study released in January 1999 found that state
administrators by and large distrust programs that give money directly
to individuals to hire their own personal assistance.
study, (also available as a word document - link
to download), was conducted by the National
Institute on Consumer-Directed Long Term Services and
257 administrators of state departments of aging, Medicaid, mental retardation/developmental
disabilities and vocational rehabilitation in all 50 states to get an
idea of what they thought of giving people funds to hire personal assistance
workers. Nearly half of the state administrators in the study said they
had concerns about "the lack of quality assurance" when people hire
their own assistants.
were also worried about fraud and abuse in the programs; and they felt
that running programs that let people hire their own assistants "could
be difficult to implement."
Terms and more terms
are really two "models":
home "health care" services under the "medical model," and
personal assistance services under the "independent living model."
delivered through a provider agency by "caregivers" who are supervised
by medical "professionals";
case management to "coordinate services"
often want to set laws and regulations to ensure "quality of care" in
agency programs. And with good reason -- many agencies have problems
with abuse and other issues. (See our page on Safety.
often give great weigh to the judgement of "professional staff" in these
home "health care" agencies. In fact, many state officials distrust
the idea of people using state funds to hire their own assistance.
personal assistance services
is the term used to describe the other approach.
and Counseling is a term for a new "model" that is really just "consumer
direction" -- with the added idea of getting "counseling" to help with
things like money management. It's a way for the admnistration to confirm
by studies what the independent living movement has wanted for years
-- control of one's own personal assistance services.
1996, four states -- Arkansas, Florida, New Jersey and New York-- were
funded by The Robert Wood Johnson Foundation and the Office of the Assistant
Secretary for Planning and Evaluation at the U.S. Department of Health
and Human Services "to test the idea of giving Medicaid recipients with
disabilities the choice of traditional services or cash along with counseling
bureaucratic terms, this is referred to as a "demonstration assessing
the use of cash payments directly to people with disabilities."
University of Maryland Center on Aging was designated to be the national
program office responsible for directing and coordinating the demonstration,
providing technical assistance to the states, in collaboration with
the National Council on the Aging, Inc.
October, 1998, the four states were granted Medicaid waivers from HCFA
to actually carry out the Cash and Counseling with Medicaid dollars.
four-state effort is an attempt to develop hard data that will satisfy
state administrators of Medicaid programs and "prove the value" of giving
money directly to individuals to hire their own in-home assistance.
can use the cash allowance to meet their personal assistance needs in
the way they think best. Those who receive the cash payments will have
available to them fiscal intermediary (i.e. bookkeeping and accounting)
services and counseling on the hiring, training, and management of personal
project's evaluation component is being conducted by Mathematica Policy
an overview of the Cash and Counseling Project at http://www.inform.umd.edu/EdRes/Colleges/HLHP/AGING/CCDemo/NCILmemo.html
more about the Cash and Counseling programs from the University
of Maryland Program on Aging.
of Cash and Counseling programs from Consumer
Freedom Clearinghouse is a project of
Free Hand Press,
publisher of Mouth
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