national governor’s association winter meeting 2008 health & human services committee...
TRANSCRIPT
National Governor’s Association
Winter Meeting 2008Health & Human Services
Committee
Presentation by:William A. B. Ditto, MSW, LSW
DirectorNew Jersey Division of Disability Services
Cash & Counseling: Program Overview Funders
The Robert Wood Johnson Foundation US DHHS/ASPE Administration on Aging/DHSS
Waiver and Program Oversight Centers for Medicare and Medicaid Services (CMS)
National Program Office Boston College Graduate School of Social Work
Original Evaluator Mathematica Policy Research, Inc.
Why Did New Jersey Choose to Undertake this Project ? Demographic Concerns Consumer dissatisfaction/agency limitations Cost control of Personal Care Assistant (PCA)
services Support of informal caregivers Increase personal responsibility & empower
individuals and families Create greater flexibility in service delivery It is a “values” driven service system
Original Cash & Counseling Demonstration OverviewDemonstration States
Arkansas, Florida, New Jersey
Study Populations Adults with disabilities (Ages 18-64) Elders (Ages 65+) Florida only: Children with developmental disabilities
Feeder Programs Arkansas and New Jersey: Medicaid personal care option programs Florida: Medicaid 1915c Home and Community-Based long-term
care waiver programs
Basic Model for Cash & Counseling
Step 1: Consumers receive traditional assessment and care plan
Step 2: A dollar value is assigned to that care plan
Step 3: Consumers receive enough information to make unbiased personal choice between managing individualized budget or receiving traditional agency-delivered services
Basic Model for Cash & Counseling
Step 4: Consumer and counselor develop spending plan to meet consumer’s personal assistance needs
Step 5: Cash allowance group provided with financial management and counseling services (supports brokerage)
Original and Expansion Cash & Counseling States
Very Satisfied with Overall Care Arrangements
68
505657
68
52
71
27
54
42
35 37
4748
0
10
20
30
40
50
60
70
80 Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
**** **
****
Had an Unmet Need for Help with
Personal Care
41
34
55
37
47
58
4543
3633
4446
2726
0
10
20
30
40
50
60Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
**
**
**
*
*
Very Satisfied with Way Spending Life These Days
43
64
38
56
36
4752
29
23
50
21
37
2825
0
20
40
60
80 Non-Elderly Adults
*, ** Significantly different from control group at .05, .01 level, respectively.
Percent
T C AR
Elderly Adults Children
T C FL
T C NJ
T C AR
T C FL
T C NJ
T C FL
****
**
****
**
*
Effects on non-PCA Medicaid Expenditures
Other Medicaid Costs Moderately Lower For Treatment Group in Each Age Group in All Three States
The Best Example: In AR , Compared to Control Group, Treatment Group Had
40% Fewer Admissions to Nursing Facilities in Second Year
Effect on Total Medicaid Costs
In AR, No Significant Difference by End of Year 2 Reductions in NF and other Waiver Costs Off-Set Increase in
Personal Care Costs
In NJ and FL, Costs Up 8-12%, But States Learned How to Control Costs
Higher Costs in AR and NJ Due to Failure of Traditional System
Policy Implications Can increase access to necessary care
Greatly improves quality of life (all ages)
Caregivers also benefit greatly
Consumers are prudent purchasers
Participants establish and maintain better “community connections”
Questions/Want More Information?
William A. B. Ditto, Director
Division of Disability Services
New Jersey Department of Human Services
222 South Warren Street, PO Box 700
Trenton, NJ 08625-0700
609 292-7800