29568
document
How does Cash and Counseling affect costs ? OBJECTIVE To test the effect of a consumer-directed model ( Cash and Counseling ) of Medicaid personal care services ( PCS ) or home- and community-based waiver services ( HCBS ) on the cost of Medicaid services . DATA SOURCES/STUDY SETTING Medicaid claims data were collected for all enrollees in the Cash and Counseling demonstration . Demonstration enrollees included those eligible for PCS ( in Arkansas ) , those assessed to receive such services ( in New Jersey ) , and recipients of Medicaid HCBS ( in Florida ) . Enrollment occurred from December 1998 through April 2001 . The follow-up period covered up to 24 months after enrollment . STUDY DESIGN Demonstration volunteers were randomly assigned to have the option to participate in Cash and Counseling ( the treatment group ) , or to receive Medicaid services as usual from an agency ( the control group ) . Ordinary least squares regressions were used to estimate the effect of the program on costs for Medicaid PCS/waiver services and other Medicaid services , while controlling for consumers ' preenrollment characteristics and preenrollment Medicaid spending . Models were estimated separately for nonelderly and elderly adults in each state and for children in Florida . DATA EXTRACTION METHODS Each state supplied claims data for demonstration enrollees . PRINCIPAL FINDINGS Largely because the program increased consumers ' ability to get the authorized amount of paid care , expenditures for personal care/waiver services were higher for the treatment group than for the control group in each state and age group , except among the elderly in Florida . Higher costs for personal care/waiver services were partially offset by savings in other Medicaid services , particularly those related to long-term care . During year 1 , total Medicaid costs were generally higher for the treatment group than for the control group , with treatment-control cost differences ranging from 1 percent ( and statistically insignificant ) for the elderly in Florida to 17 percent for the elderly in Arkansas . In year 2 , these cost differences were generally greater than in year 1 . Only in Arkansas did the treatment-control difference in total cost shrink over time-to less than 5 percent ( and statistically insignificant ) in year 2 . CONCLUSIONS Medicaid costs were generally higher under Cash and Counseling because those in the traditional system did not get the services they were entitled to . Compared with the treatment group , ( 1 ) control group members were less likely to receive any services at all ( despite being authorized for them ) , and ( 2 ) service recipients received a lower proportion of the amount of care that was authorized . In addition , a flaw in Florida 's reassessment procedures led to treatment group members receiving more generous benefit amounts than control group members . To keep total Medicaid costs per recipient at the level incurred under the traditional system , consumer-directed programs need to be carefully designed and closely monitored .
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Intervention_Educational
Cash and Counseling
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Intervention_Educational
Cash and Counseling
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Intervention_Educational
Cash and Counseling
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Intervention_Control
Medicaid services as usual from an agency
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Intervention_Educational
Cash and Counseling
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Outcome_Other
costs for Medicaid PCS/waiver services
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Outcome_Other
Medicaid services
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Outcome_Other
expenditures for personal care/waiver services
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Outcome_Other
costs for personal care/waiver services
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Outcome_Other
total Medicaid costs
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Outcome_Other
cost differences
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Outcome_Other
cost shrink over time-to
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Outcome_Other
Medicaid costs
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Outcome_Other
receive any services
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Outcome_Other
lower proportion of the amount of care
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Participant_Condition
personal care services ( PCS )
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Participant_Age
nonelderly
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Participant_Age
elderly adults
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Participant_Age
children