New State strategies to meet long-term care needs

Health Affairs

Volumn 29, Issue 1, 2010, Pages 49-56

  Doty, Pamela ^a   Mahoney, Kevin J ^b,c   Sciegaj, Mark ^d,e  

^a U S DEPARTMENT OF HEALTH AND HUMAN SERVICES   (United States)

^b BOSTON COLLEGE   (United States)

^c National Resource Center for Participant Directed Services   (United States)

^d Smart Spaces Center for Adaptive Aging in Place ^*  (United States)

^e PENNSYLVANIA STATE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BUDGET; COMMUNITY CARE; CONSUMER; COST; COUNSELING; HEALTH PROGRAM; HOME CARE; LONG TERM CARE; MEDICAID; REVIEW;

AGED; COMMUNITY HEALTH PLANNING; CONSUMER PARTICIPATION; FINANCING, GOVERNMENT; GOVERNMENT PROGRAMS; HEALTH PLANNING GUIDELINES; HEALTH SERVICES NEEDS AND DEMAND; HUMANS; INSURANCE, LONG-TERM CARE; LONG-TERM CARE; MEDICARE; PROGRAM DEVELOPMENT; REIMBURSEMENT, INCENTIVE; STATE GOVERNMENT; UNITED STATES;

EID: 77957355173     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2009.0521     Document Type: Review

References (19)

1. Doty P, Kasper J, Litvak S. Consumer-directed models of personal care. Milbank Q. 1996;74(3):377-409.
2. Doty P, Benjamin AE, Matthias R, Franke T. Home supportive services for the elderly and disabled: a comparison of client-directed and professional management of services delivery. Non-Technical Summary Report [Internet]. Washington (DC) : Office of the Assistant Secretary for Planning and Evaluation, U. S. Department of Health and Human Services; 1999 [cited 2009 Oct. 21]. Available from: http://aspe.hhs.gov/daltcp/reports/ihss.htm
3. Bradley V, Agosta J, Smith G, Taub S, Ashbaugh J, Silver J, et al. The Robert Wood Johnson Foundation self-determination initiative: final impact assessment report. Cambridge (MA) : Human Services Research Institute; 2001.
4. For a comprehensive overview of evaluation results, see Benjamin AE, editor. Putting consumers first in long-term care: findings from the Cash and Counseling demonstration and evaluation. Health Serv Res. Special Issue. 2007;42(1).
5. Cash and Counseling reports as well as links to articles published in journals are available from http://www.cashandcounseling.org
6. Among states surveyed, twenty-five reported that Cash and Counseling was part of their strategy or planning for 2007; fifteen reported that such programs were under consideration for 2008 or later. Greene J. State approaches to consumer direction in Medicaid [Internet]. Hamilton (NJ) : Center for Health Care Strategies Inc.; 2007 [cited 2009 Nov. 23]. Available from: http://www.chcs.org/usr-doc/State-Approaches-to-Consumer-Direction.pdf
7. CMS officials Suzanne Bosstick and Mary Sowers report that they seldom review home and communitybased services waiver applications (new or renewals/amendments) that do not include consumer direction. Five states have approved 1915 (j) "cash and counseling" stateplan amendments, and CMS official Marguerite Schervish reported that three additional states had such amendments in process as of July 2009. Personal communication with the lead author; 21 October 2009.
8. A comprehensive inventory of publicly funded consumer-directed services is under way, but not yet completed, under the direction of Mark Sciegaj.
9. Ng T, Harrington C, O'Malley M. Medicaid home and communitybased service programs: data update [Internet]. Washington (DC) : Kaiser Commission on Medicaid and the Uninsured; 2008 Dec. [cited 2009 Oct. 31]. Available from: http://www.kff.org/medicaid/7720.cfm
10. Calculating participation rates in consumer-directed services is difficult not only because some programs do not keep good statistics but also because sizable minorities of home and community-based services recipients live in group homes or assisted living, which makes them ineligible. Although total national enrollment is currently unknown, the numbers enrolled in longstanding employer-authority programs in a handful of populous states alone (such as California, Michigan, Massachusetts, and New York) exceed 500, 000.
11. The National Center for Participant-Directed Services at Boston College, under the direction of Kevin Mahoney, updates Cash and Counseling program statistics quarterly.
12. Phillips B, Mahoney K, Simon-Rusinowitz L, Schore J, Barrett S, Ditto W, et al. Lessons from the implementation of Cash and Counseling in Arkansas, Florida, and New Jersey [Internet]. Washington (DC) : Office of the Assistant Secretary for Planning and Evaluation, U. S. Department of Health and Human Services; 2003 Jun. [cited 2009 Oct. 22]. Available from: http://aspe.hhs.gov/ daltcp/reports/cclesson.htm
13. O'Keeffe J. Implementing selfdirection programs with flexible individual budgets: lessons learned from the Cash and Counseling replication states [Internet]. Princeton (NJ) : Robert Wood Johnson Foundation; 2009 [cited 2009 Oct. 22]. Available from: http://www.cashandcounseling.org/resources/20090202- 101712
14. Crisp S, Doty P, Flanagan S, Smith G, O'Keeffe J, et al. Developing and implementing self-direction programs and policies: a handbook [Internet]. Princeton (NJ) : Robert Wood Johnson Foundation; 2009 [cited 2009 Oct. 22]. Available from: http://www.cashandcounseling.org/resources/handbook
15. Dale S, Brown R. Reducing nursing home use through consumer-directed personal care services. Med Care. 2006;44(8):760-7.
16. Carlson LB, Foster L, Dale BS, Brown R. Effects of cash and counseling on personal care and wellbeing. Health Serv Res. 2007;42(1):467-87.
17. The discussion of Arkansas' cost experience and cost containment strategies is based primarily on numerous past and recent (2008-2009) personal communications (including data shared by e-mail) between current and former Arkansas state officials (including Debby Ellis, Suzanne Crisp, Sandra Barrett, and Herb Sanderson) and the authors. Marguerite Schervish, Arkansas's CMS 1115 waiver project officer, confirmed the CMS's acceptance of Arkansas' closeout cost report and forwarded a copy to the lead author.
18. Personal communications by the lead author (most recent, June 2009) with Karen Huber, retired Florida Consumer Directed Care Program director; and Sherry Jackson, current program director.
19. Additional information on research and technical assistance (publications and other materials) related to consumer direction is available on two Web sites maintained by the Boston College National Resource Center for Participant Directed Services: http://www.cashandcounseling.org and http://www.bc.edu/ schools/gssw/nrcpds