Promoting Choice in Healthcare for Seniors
Few things are more depressing than the nursing home search many families are forced to face. Even the best options are a loooong way from home. At the Council on Foundations Conference, I heard James L. Knickman talk about a program, called Cash and Counseling, that has achieved scale and impact by harnessing market forces to promote choice in healthcare for seniors.
Cash and Counseling was jointly launched and funded by the Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services. The program gives frail elderly people and adults and children with disabilities who are eligible for Medicaid personal care services the option to manage a flexible budget and decide for themselves what mix of goods and services will best meet their personal care needs—essentially help at home with daily activities like bathing, dressing, grooming, and meal preparation.
Cash & Counseling participants may use their budget (read the dreaded “voucher” word) to hire their own personal care aides, including family members and friends, as well as purchase items or make home modifications that help them live independently.
This January, a decade after it was first launched in three states, RWJ announced “the federal Deficit Reduction Act (DRA) has made it easier for all states to introduce a Cash & Counseling option. The Centers for Medicare & Medicaid Services (CMS) now allows state Medicaid programs to offer the Cash & Counseling model of self-directed personal assistance services to frail elders and adults and children with disabilities without first obtaining a federal waiver. Prior to January 1, 2007, any state interested in introducing a Cash & Counseling option was required to seek and receive an 1115 or 1915c waiver from CMS.”
When Knickman was at RWJ as the head of evaluation (he is now head of the New York State Health Foundation), he joked that few programs came in with clearly positive results. But Cash and Counseling was one of them. The results show that the program’s emphasis, which gave seniors the right to control their healthcare and to be cared for by friends or neighbors rather than strangers, significantly increased the percentage that were “very satisfied with life.”
RWJ is one of the those foundations big enough and bold enough to go after public policy initiatives that will widely benefit their targeted constituents and fulfill their mission to improve the “health and healthcare of all Americans.” Leverage their investment to make this happen in your state?