INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Early Lessons from the Cash and Counseling Demonstration and Evaluation


Today, in most states, whether you are an elderly individual or a younger person with disabilities, if you are covered by Medicaid and need assistance to perform major activities of daily living like bathing, dressing, using the toilet, transferring from one place to another, or eating, you will not have much say over who helps you or when they come--never mind what they actually do. For years, people with disabilities have been saying, "If I had more control over my services, my quality of life would improve, and I could meet my needs for the same amount of money or less." The project described in this article is, at its heart, a policy-driven evaluation of this conviction. The Cash and Counseling Demonstration and Evaluation, funded by the Robert Wood Johnson Foundation (RWFJ) and the Office of the Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services, provides a test of one of the most unfettered forms of consumer direction, offering consumers a cash allowance in lieu of agency-delivered services.