Tried in 3 states, a pilot program may be replicated
April 16, 2003
By Laura Meckler
People with disabilities who rely on Medicaid to pay for help bathing,
eating, and housecleaning were much happier under an experimental program
that let them hire the helpers, a study concludes.
Medicaid, the health care program for the poor, traditionally hires people to assist some 1.2 million people with disabilities who need help with basic activities of daily life. Under an experimental program, patients get the money directly and decide how to spend it. They can hire whomever they want to help provide care, including friends and family.
''Apparently, [participants] find that having intimate care, such as help with bathing and dressing, performed by a person of one's own choosing is much more satisfying that having it performed by a stranger,'' said the study, released yesterday, by researchers at Mathematica Inc.
The program, called ''Cash and Counseling,'' is running in three states, and the Bush administration would like to see it spread further. The study, published on the journal Health Affairs' website, examined consumer satisfaction in Arkansas' program. Future research will examine other aspects of the program and will look at its implementation in the other states, New Jersey and Florida.
The study surveyed 1,739 people who receive disability services in Arkansas' program. Just over 70 percent were age 65 and older; others were younger.
Participants received an average of $320 per month to hire helpers, buy supplies or assistive devises, or modify their homes.
Disabilities that qualify for home services under Medicaid include stroke, severe congestive heart failure, spinal cord injuries, brain damage, and multiple sclerosis.
People who needed home services were randomly assigned to either the experimental group or to a control group that received traditional services.
The surveys found that people in the experimental group were ''much less likely'' than the traditional group to report that paid caregivers performed poorly, and more likely to say that they performed ''exceptionally well.'' They were less likely to report unmet needs.
Further, both older and younger people in the experiment were nearly 20 percentage points more likely than others to say they were very satisfied with the way they were spending their lives.
They were also no more likely to have health problems or accidents related to their care.
Researcher Jennifer Schore, a co-author of the study, cautioned that more data is needed from other states and about other aspects of the program before it can be declared a success. Still, Health and Human Services Secretary Tommy Thompson welcomed the results.
''This approach gives people with disabilities more freedom and responsibility, in the same way that all of us want to be in charge of our lives and our choices,'' he said in a statement.
The study was paid for by HHS and the Robert Wood Johnson Foundation.
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