From a federal perspective, the Cash and Counseling Demonstration and Evaluation is an outgrowth of and beneficiary of lessons learned from years of previous research on "consumer-direction" and of serious reflection on the meaning and significance of earlier social experiments with financing and delivering home- and community-based services. Cash and Counseling represents a highly visible test of the effects of maximizing consumer choice and control over the supportive services that elderly and younger people with disabilities need to meet their needs for assistance in the community. However, Cash and Counseling also represents a hopeful effort on the part of its federal sponsors to move to beyond the impasse at which the policy debate on home- and community-based services has seemingly been stuck for nearly two decades. Cash and Counseling is an experiment that puts the responsiveness of public programs to the needs and preferences of low-income people with disabilities front and center, instead of defining the main or only value of home- and community-based services in terms of providing cost-effective "alternatives" to institutional care.
Pamela Doty, Ph.D., is senior policy analyst, Office of the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington D.C.