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Program Overview

Cash & Counseling offers Medicaid consumers who have disabilities more choices about how to get help at home. Specifically, it gives frail elders and adults with disabilities the option to manage a flexible budget and decide for themselves what mix of goods and services will best meet their personal care needs. In some states, children with developmental disabilities are also served. Cash & Counseling participants may use their budgets to hire their own personal care aides as well as purchase items or services, including home modifications that help them live independently. The Cash & Counseling Vision Statement fully describes the essential components of the model.

Cash & Counseling was sponsored by The Robert Wood Johnson Foundation (RWJF), the Office of the Assistant Secretary for Planning and Evaluation in the United States Department of Health and Human Services (ASPE/DHHS), and the Administration on Aging (AoA). With the cooperation of the aforementioned agencies and the National Program Office located at the Boston College Graduate School of Social Work, a three state Cash & Counseling Demonstration was implemented in 1998 to compare the Cash & Counseling consumer-directed model with the traditional agency-directed approach to delivering personal assistance services. Following the success of the Original Demonstration, funders granted an expansion of the Cash & Counseling program. The vision guiding this expansion was the promise of “a nation where every state will allow and even promote a participant-directed individualized budget option for Medicaid-funded personal assistance services." The replication state grants ended in early 2009, however, the 15 Cash & Counseling states continue to operate their projects.

The National Program Office at the Boston College Graduate School of Social Work directed the original demonstration and the replication project. Following the end of the grant period, the National Program Office evolved to become the National Resource Center for Participant-Directed Services (NRCPDS).

Find out if your state offers a Cash & Counseling program and find contact information on our State Map

The federal government recently made it significantly easier for any state to introduce a Cash & Counseling option through new provisions in the 2005 Deficit Reduction Act. As of January 2007, federally approved “waivers” are no longer required for states to offer flexible budgets to eligible Medicaid consumers and their families so that they may purchase the disability services and supports of their choosing. In addition, the 2006 reauthorization of the Older Americans Act (OAA) makes it possible to now include a Cash & Counseling option in the provision of OAA-funded services.