NCPA - National Center for Policy Analysis

Consumer Choice Provides Better Medicaid Services

April 21, 2003

About 1.2 million Medicaid beneficiaries receive disability-related support services in their homes. Most receive them from government-regulated agencies whose professional staff arrange services and monitor quality. However, many Medicaid recipients report little control over the provision of care, resulting in dissatisfaction and unmet needs.

A growing number of Medicaid recipients have begun to manage their support services themselves under a nationwide program that provides counseling and gives consumers a flexible monthly allowance to purchase disability-related goods and services. The program, IndependentChoices, generally operated smoothly and the results have been impressive. Researchers who surveyed 1,739 elderly and nonelderly participants in Arkansas found that:

  • Those in the programs were much less likely to report that their paid caregivers performed poorly, while they were more likely to say that caregivers performed exceptionally well.
  • About 60 percent fewer respondents said that their paid caregivers failed to complete tasks.
  • Similarly, the proportion who said that their paid caregivers sometimes did not visit as scheduled was much lower than those not participating in the program.
  • Participants were much more satisfied with their caregivers' schedules and were much more likely to be "very satisfied" with the way their paid caregivers performed their duties.

After nine months, only about 15 percent had chosen to stop participating in the program. The fact that 96 percent of all participating respondents, including disenrollees, said that they would recommend the program to others confirms that even disenrollees found IndependentChoices to be a desirable alternative to agency care.

Source: Leslie Foster, et al., "Improving The Quality Of Medicaid Personal Assistance Through Consumer Direction," Health Affairs, Web Exclusive, March 26, 2003.

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