Does Consumer Direction Affect the Quality of Medicaid Personal Assistance in Arkansas?

As states seek to improve supportive services, policymakers need to know whether consumer-directed programs deliver quality care — that which satisfies consumers' preferences and does not harm their health. The need for evidence grows daily, as states respond to federal Systems Change grants and other initiatives spurred by the Supreme Court's 1999 Olmstead decision and the Bush administration's subsequent New Freedom Initiative. The national Cash and Counseling Demonstration is an innovative model of consumer direction and is the first to use a randomized design to compare care quality under agency- and consumer-directed approaches. This analysis presents findings from the first of three demonstration programs to be implemented, Arkansas's IndependentChoices. [61 PDF pages]