The Cash and Counseling Demonstration gives Medicaid beneficiaries who are eligible for personal care services a consumer-directed allowance in lieu of traditional agency services. Using survey and Medicaid claims data on 2,008 adult applicants randomly assigned to treatment or control groups,...

This report estimates the effects of Cash and Counseling on caregivers who were providing the most unpaid assistance to adult beneficiaries at the time beneficiaries volunteered for the demonstration. Despite variations in design and implementation across states, all three demonstration programs...

Finds that many in the early treatment group cohort were in relatively poor health and had high levels of functional impairment. Still, one-third lived alone, and one-quarter had no unpaid informal caregivers. Most used the monthly cash allowance to hire a caregiver on their own; the majority of...

A growing number of Medicaid beneficiaries receiving disability-related assistance in their homes hire workers and manage the services themselves under consumer-directed care. Although consumer direction clearly benefits beneficiaries, it is sustainable only if workers are satisfied with their...