Cash & Counseling’s Effects on the Amount and Quality of Care Received

1. Cash & Counseling’s Effects on the Amount and Quality of Care Received Barbara Lepidus Carlson AcademyHealth Annual Research Meeting June 26, 2005 Boston, MA

2. Intended Effects • Medicaid consumers with disabilities direct their personal care • Change use of goods and services • Satisfaction and quality of life improve • No adverse effects on health

3. 9-Month Survey Sample

4. Selected Baseline Characteristics • 15 to 40% dissatisfied with care • 2/3 needed help to get out of bed • 0 to 1/3 live alone • 1/6 to 1/2 in poor health • 1/6 to 1/3 Black • Arkansas – 40% rural, few Hispanic • New Jersey – few rural, 1/3 Hispanic

5. Receiving Monthly Allowance at 9 Months (Treatment Group Members Living in Community) Percent Non-Elderly Adults Children Elderly Adults FL FL AR NJ AR FL NJ

6. Monthly Allowance Amounts at Enrollment

7. Receiving Paid Assistance at 9 Months Non-Elderly Adults Percent Children Elderly Adults ** ** ** ** ** ** T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

8. Hours of Paid Care at 9 Months(During Past Two Weeks) Hours Non-Elderly Adults Children Elderly Adults ** * ** ** ** T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

9. Hours of Unpaid Care at 9 Months(During Past Two Weeks) Hours Non-Elderly Adults Children Elderly Adults ** * * ** T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

10. Total Hours of Care at 9 Months(During Past Two Weeks) Hours Non-Elderly Adults Children Elderly Adults * * T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

11. Summary of Results on Satisfaction with, and Quality of, Paid Care

12. Had an Unmet Need for Help with Personal Care Percent Non-Elderly Adults Children Elderly Adults * ** ** * ** T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

13. Paid Caregiver Neglected Client Percent Non-Elderly Adults Children Elderly Adults ** * ** ** ** T C NJ T C FL T C NJ T C FL T C AR T C AR T C FL *, ** Significantly different from control group at .05, .01 level, respectively.

14. Very Satisfied with Overall Care Arrangements Percent Non-Elderly Adults Children Elderly Adults ** ** ** ** ** ** T C NJ T C FL T C NJ T C FL T C AR T C AR T C FL *, ** Significantly different from control group at .05, .01 level, respectively.

15. Very Satisfied with Way Spending Life These Days Percent Non-Elderly Adults Children Elderly Adults ** ** ** ** ** ** * T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

16. Contractures Developed or Worsened Percent Non-Elderly Adults Children Elderly Adults ** * * T C NJ T C FL T C NJ T C FL T C FL T C AR T C AR *, ** Significantly different from control group at .05, .01 level, respectively.

17. Conclusions • Cash & Counseling increases satisfaction • More people receive paid care • Fewer total hours of care • Works for elderly as well as disabled • No adverse health outcomes • Programs need to help consumers with steps necessary to receive allowance