Cash and Counseling is an expanded model of consumer-directed supportive services in that it provides a flexible monthly allowance that beneficiaries--as consumers--may use to hire their choice of workers, including family members, and to purchase other goods and services (as their state permits). Cash and Counseling requires consumers to develop plans showing how they would use the allowance to meet their personal care needs and provides counseling and fiscal assistance to help them plan and manage their responsibilities. Consumers who are unable or unwilling to plan and manage their care themselves may designate a representative, such as a family member, to help them or to do it for them. These features are meant to make Cash and Counseling adaptable to consumers of all ages and with all types of disabilities.
With funding from The Robert Wood Johnson Foundation and the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services, the Cash and Counseling Demonstration and Evaluation was implemented as a voluntary demonstration in three states--Arkansas, Florida, and New Jersey.2 Because the Medicaid programs and political environments differed considerably across the demonstration states, they were not required to implement a standard intervention, but had to adhere to basic Cash and Counseling tenets, as summarized above. Because of such differences, Mathematica Policy Research, Inc. (MPR) is evaluating each program separately.