BC's Kevin Mahoney develops new
choices for the elderly and disabled
Boston College's Graduate School of Social
Work has been awarded a $7 million grant from the Robert Wood Johnson
Foundation to expand the Cash and Counseling program piloted by associate
professor Kevin Mahoney. The program gives disabled and elderly Americans
who qualify for Medicaid more of the discretion that other health care
consumers have when they hire aides or purchase items to make their
lives easier.
Under traditional Medicaid, individuals who need
help with daily activities such as bathing or housework must rely on
state-contracted home care. In Cash and Counseling, participants are
given funds based on what Medicaid would expect to pay out on their
behalf. They can engage the services of relatives or friends; they can
buy their own equipment; they can even let the money accumulate in a
special account in order to save for a large purchase or to create an
emergency fund. Mahoney cites the example of one recipient, a woman
with multiple sclerosis: Under traditional Medicaid, he says, "the
home care worker could come and help her do her laundry, but
she couldn't help her do her children's laundry, because the Medicaid
benefit was just for the mother." Through Cash and Counseling,
the woman could use funds in ways traditional Medicaid does not allow—buying
a washing machine, for example. A consultant would work with her closely
to develop an individualized budget, handle paperwork, even recruit,
train, and pay the caregivers of her choosing. Mahoney says one man
whose adult son had spina bifida was able to retire early and provide
full-time care for his son himself with the wage obtained through the
program, rather than see him enter a nursing home.
The Cash and Counseling model has been tested
in three states since 1995—Arkansas, Florida, and New Jersey.
The longest-running program, Arkansas's IndependentChoices, was evaluated
last year by a public policy research firm, and the results were published
in the journal Health Affairs. Among the findings: Only 6 percent
of non-elderly consumers enrolled in IndependentChoices were dissatisfied
with their care, compared to one-third of those receiving traditional
Medicaid. Roughly 75 percent of participants surveyed hired friends
or relatives, for everything from constant personal care to odd jobs.
And within two years of the program's launch, spending on nursing homes
and hospitals declined in comparison with results from a control group.
IndependentChoices "fits the rhythm of my life," one participant
said.
With the GSSW's new grant, supported also
by the U.S. Department of Health and Human Services, 10 more states
will receive $250,000 each over three years to implement Cash and Counseling,
with an additional $100,000 going to up to three of those states to
extend the approach to other facets of public assistance. Cash and Counseling
is not for everyone, says Mahoney. Consumers unable or unwilling to
make decisions about their care, and who choose not to name a representative
to do so on their behalf, may still rely on the state to arrange services.
The program won't replace the current system, says Mahoney, but
it can be a valuable addition to the Medicaid menu.
Nicole Estvanik
Photo: Associate professor Kevin Mahoney,
of Cash and Counseling. By Lee Pellegrini
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