Healthcare Coverage & Access

This report describes the implementation of consumer directed care by synthesizing information from in-person discussions with program staff, a mail survey of program consultants, telephone interviews with consumers in the treatment group, and program records.

This report examines the effects of the Cash and Counseling program in three states — Arkansas, Florida, and New Jersey — regarding how consumer direction affects the use and quality of both paid and unpaid personal care assistance received by consumers, as measured by consumers' satisfaction with care, the frequency of unmet needs, and the incidence of adverse health events arising f

This paper examines health care spending and the impact on the economy of the United States. The relationship between health care spending growth and the U.S. economy is inherently complex and multidimensional. Rising health care spending can be viewed as both a weight on broader economic growth and as a driver of sectoral and local prosperity. [PDF - 9 pages]

This report describes the design and implementation of the Consumer-Directed Care Research Project (CDC), Florida's model of Cash and Counseling, and draws lessons from the state's experience. The report is based primarily on in-person interviews conducted in January 2002, about 18 months after the project began enrolling beneficiaries.

U.S. Department of Health and Human Services

Past studies by federal agencies examined the impact of the Balanced Budget Act of 1997 policies on beneficiaries and providers. While documenting changes in the supply of home health agencies (HHAs), these studies concluded that agency closings did not cause a shortage of Medicare home health providers and that beneficiaries' access to services were not generally affected.

Cash and Counseling, an innovative model of consumer direction, has been implemented as a three-state demonstration designed to weigh the advantages and disadvantages of allowing Medicaid beneficiaries to assume more responsibility for the supportive services they may need.

Implementation of the 1997 Balanced Budget Act's home health provisions dramatically reduced Medicare home health utilization and led to closures of many agencies. This paper examined the potential effects of the agency closings on beneficiary utilization rates. Findings suggest that agency closings, per se, had only a very small impact on changes in utilization rates between 1996 and 1999.

This study provides descriptions and information about overall application procedures under four major assistance programs in a variety of venues (e.g., welfare offices, hospitals, health clinics) at six sites (Arlington, VA; Dallas, TX; Raleigh, NC; New York, NY; Seattle, WA; and Sedalia, MO).

This review updates the previous literature on what we know about inmate needs and the programs designed to address those needs. A more neutral terminology than inmate "deficits" or "needs" is used by referring to the different domains as "skill sets." A skill implies mastery and competence rather than a personal liability.