A demonstration of home-and-community-based care under the Medicaid program was evaluated in three states. Arkansas, New Jersey, and Florida tested a consumer-directed model of delivering (“1115” waiver) Medicaid-funded care to low-income individuals with chronic functional disabilities. The demonstration included the elderly, adults 18-64 with adult-onset disabilities, and adults and children with developmental disabilities (including mental retardation). This demonstration included a controlled experimental design evaluation jointly funded by the Robert Wood Johnson Foundation and ASPE. Volunteer enrollees were randomly assigned either to a treatment group whose members were eligible to receive monthly budgets in lieu of traditional services or to the control group whose members were eligible only for services from home care agencies or other traditional service providers. After a three year planning phase, the states implemented their experimental programs. Data collection for the evaluation took place during 1998-2002. Data analysis and publication of findings began in 2002 and will be completed in 2005. Across all three states and all target populations, statistically significant findings in favor of the experimental intervention were found on a wide variety of measures of quality and access to care. Results for the consumer-directed approach were strongly positive with respect to measures of “quality” of care and access to help when needed, including reduction of unmet needs for assistance. Treatment group members experienced adverse health events (e.g. bedsores, contractures, falls) no more frequently than control group members; indeed, on some measures, for some subgroups, adverse events occurred less frequently in the treatment group. Cost findings were mixed. The experimental intervention had been designed to be budget neutral because individual budget allotments could not exceed (and were typically set lower) than the projected cost of providing authorized services via traditional providers. However, an unexpected finding of the evaluation was that the traditional service system actually “saved” money by doing a poorer than expected job of delivering the full amount of personal care services to which Medicaid beneficiaries were entitled. In one participating state, reductions in nursing home use and use of other Medicaid services among treatment group members were sufficient to offset the higher costs that resulted from treatment group members receiving a much larger share of their entitled personal care services.
PIC ID: 8054.3; Agency Sponsor: ASPE-ODALTCP, Office of Disability, Aging, and Long-Term Care Policy; Federal Contact: Doty, Pamela, 202-690-6443; Performer: University of Maryland, Center on Aging, College Park MD