Skip to Main Page Content Skip to the About Us section submenu

About Us

 

C&C FAQ

  1. What is Cash & Counseling?
  2. Does Cash & Counseling increase states' Medicaid costs?
  3. Under Cash & Counseling, is the state paying for services that used to be provided for free?
  4. Is it right for the state to pay family members and friends for taking care of their loved ones?
  5. Does having the Cash & Counseling option increase consumers' demands for services?
  6. A previous Cash & Counseling study found that health outcomes were the same for Cash & Counseling enrollees and a control group enrolled in the traditional agency model. Considering the control group received fewer services and had the same health outcomes, what is the value of the additional services provided under Cash & Counseling?
  7. What are the selling points of Cash & Counseling to the consumer?
  8. What are the consumer's specific responsibilities under Cash & Counseling?
  9. Is Cash & Counseling part of the Deficit Reduction Act (DRA)?
  10. How can I find out more about the 2007 Administration on Aging Grants which included a Cash & Counseling option?

1. What is Cash & Counseling? [top]

Cash & Counseling is a program that gives elderly and disabled Medicaid consumers who receive personal assistance services the option of directing their own care. These services include help with everyday needs like bathing, dressing, grooming, cooking, and housekeeping. Traditionally, state Medicaid programs have contracted with home care agencies to provide these services. Although consumers may choose from among available agencies, they often have little say in who will provide these very personal services or even when or how services are provided.

The Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services established Cash & Counseling so that informed Medicaid consumers could make their own choices about the personal assistance services they receive. By redirecting personal assistance funds from agencies to consumers themselves, Cash & Counseling allows people to hire whomever they want to provide their care and decide for themselves if they would rather purchase a microwave oven to heat up their meals or hire an aide to cook for them.

The counseling side of Cash & Counseling provides consumers with assistance in planning their budgets, keeping up with the paperwork required to pay an employee's wages and withhold taxes, and accounting for expenditures.

Cash & Counseling is giving choice back to Medicaid consumers. It's improving their quality of life, increasing their satisfaction, and reducing their unmet care needs - without increasing costs when compared to a well-functioning traditional care system.

2. Does Cash & Counseling increase states' Medicaid costs? [top]

Cash & Counseling does not increase states' Medicaid costs, if people receive the care to which they are entitled under the traditional system. This conclusion is based on the findings of the evaluation of the original Cash & Counseling Demonstration and Evaluation program in Arkansas, Florida, and New Jersey.

In each age group in each state, Cash & Counseling participants had lower expenditures on other Medicaid services - such as nursing homes, home health, and other home care waiver services. These savings in other Medicaid costs partially offset Cash & Counseling's higher personal assistance costs that, in most cases, resulted from traditional agencies' failure to deliver services.

  • In Arkansas, there was a 40% reduction in nursing home admissions in the second year of the program, and the TOTAL Medicaid cost per person under Cash & Counseling was about the same as that for the traditional agency model.
  • In Florida and New Jersey, total Medicaid costs under Cash & Counseling were up approximately 8-12%, but Cash & Counseling also offers lessons in how to control these costs. Cash & Counseling doesn't have to cost any more than a traditional agency model that delivers approved services.

The conclusion for us is this: If the traditional system were to provide a comparable level of services, costs would be no greater under the cash option. People are entitled to these services under Medicaid law.

3. Under Cash & Counseling, is the state paying for services that used to be provided for free? [top]

The services paid for by the state are all part of the consumer's authorized care plan. What's different is that, in many cases, family members and friends chosen by the consumer are providing those services instead of an agency worker.

4. Is it right for the state to pay family members and friends for taking care of their loved ones? [top]

Family caregivers are the backbone of our country's long-term care system, providing millions of hours of care every year for no compensation and frequently at great cost to their own emotional health. They're burned out and exhausted from juggling work, family responsibilities, and caregiving. In addition, many caregivers have to reduce their work hours or even give up their jobs to take care of their loved ones.

By supporting caregivers, we're helping them hang in longer, and, hopefully, relieving some of their stress. Keep in mind, that even with Cash & Counseling support, family caregivers are typically paid lower-than-average wages and, in most cases, are paid for only a small fraction of the hours of service they provide.

5. Does having the Cash & Counseling option increase consumers' demands for services? [top]

Cash & Counseling does not increase the need for personal care. Some people, however, would forgo services if they had to use an agency. Keep in mind that we're talking about very personal services - bathing, dressing, cooking, and eating, and some people feel uncomfortable getting those kinds of services from strangers. Cash & Counseling gives these people a better alternative. Under Cash & Counseling, Medicaid consumers can receive personal care services from people they choose and trust.

6. A previous Cash & Counseling study found that health outcomes were the same for Cash & Counseling enrollees and a control group enrolled in the traditional agency model. Considering the control group received fewer services and had the same health outcomes, what is the value of the additional services provided under Cash & Counseling? [top]

First and foremost, Cash & Counseling is a program focused on improving the quality of life for Medicaid consumers who need personal care services - and seeks to do so without increasing costs. Our studies show that, by every measure, Cash & Counseling is succeeding. Consumers with the cash option are getting more of the services to which they're entitled and are reporting greater satisfaction, better quality of life, and fewer unmet needs. At the same time, Cash & Counseling costs no more than the traditional system would if it were providing the same level of services.

For this study, we measured health outcomes because concerns had been raised about untrained caregivers providing services to consumers with the cash option. We wanted to make sure that Cash & Counseling did not make health outcomes worse. In fact, consumers with the cash option even fared a little better on some health outcomes than those in the control group and experienced no declines in health outcomes at all. We are thrilled with these results.

7. What are the selling points of Cash & Counseling to the consumer? [top]

Cash & Counseling is an expanded model of consumer direction; it offers consumers more choice, flexibility and control in managing their daily lives.

  • The consumer decides who provides their care
  • The consumer decides when the care is needed
  • The consumer decides what help they need
  • The consumer decides how much responsibility they want

8. What are the consumer's specific responsibilities under Cash & Counseling? [top]

The choice and flexibility offered by Cash & Counseling come with added responsibilities. Consumers who choose Cash & Counseling are responsible for:

  • Developing and following a spending plan
  • Hiring and managing their support workers
  • Following their annual budget that is based on their assessed need

9. Is Cash & Counseling part of the Deficit Reduction Act (DRA)? [top]

Cash & Counseling is a provision of the Deficit Reduction Act (DRA) of 2005. Section 6087 or 1915(j) titled “Self-Directed Personal Assistance Services Program Option (Cash & Counseling)” is effective on or after January 1, 2007. State participation in this provision is optional. Please continue to check our Current News and Publications & Resources for updates on the DRA.

10. How can I find out more about the 2007 Administration on Aging Grants which included a Cash & Counseling option? [top]

AoA’s Nursing Home Diversion Modernization grants allow for the development of Cash & Counseling programs. AoA has developed a fact sheet for the grants that provides information on key service elements. The National Program office will offer Technical Assistance to the states awarded.