MPRs evaluation of the three Cash and Counseling demonstration programs addresses four broad questions: (1) Who participated in Cash and Counseling? (2) How was it implemented? (3) How did it affect consumers and their caregivers? (4) How did it affect public costs? To estimate impacts on consumers and their caregivers and on public costs, the evaluation randomly assigned interested, eligible Medicaid beneficiaries to receive either Cash and Counseling benefits (the treatment group) or personal assistance services (PAS) as usual from Medicaid-certified agencies (the control group). It then is comparing the groups outcomes, based on responses to telephone interviews and Medicaid and Medicare claims data. In addition, the evaluation will look at beneficiaries reasons for participating or declining to participate in Cash and Counseling, based on questionnaires filled out when the beneficiary made this decision. It will also use beneficiary-level Medicaid PAS data to investigate trends in state PAS use for indirect evidence of demonstration-induced demand for PAS.3
This report, which addresses the second broad evaluation question, describes the implementation of the Arkansas demonstration, IndependentChoices, by considering:
- What were the major goals and features of IndependentChoices?
- How well did consumers manage the responsibilities of the program?
- How did consumers take advantage of the increased flexibility the program offered?
- How did consumers like the program? For what types of consumers did it appear to work best, and for whom did it work less well?
- What lessons does IndependentChoices offer policymakers and program developers about consumer direction?