Improving the Quality of Medicaid Personal Assistance Through Consumer Direction.

This article presents the first impact analysis results from a three-state demonstration in which disabled Medicaid enrollees eligible for personal assistance services get a cash allowance rather than services so they can hire whom they please or use the money to buy equipment or supplies, instead of obtaining help through a home health agency. The results from the Arkansas program show that it greatly increases their satisfaction with the quality and reliability of care. The program also reduces unmet needs for assistance, preserves health and safety, and improves outlook on life. The findings from this random assignment design provide strong support for the many states considering Medicaid program modifications that promote increased consumer direction.