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"Cash and Counseling" works, even with mental health clients
Adults with mental illnesses in the Cash and Counseling program had higher satisfaction, both with their quality of life and with their paid caregivers, compared to those receiving traditional Medicaid services, according to an April 2010 study done for the Substance Abuse and Mental Health Services Administration, Self-Directed Care in Mental Health: Learnings from the Cash & Counseling Demonstration Evaluation.
Participants also had fewer unmet needs, no more injuries or other adverse health outcomes than other recipients of services, no significant differences in total expenditures, and were able to successfully manage the cash option, the researchers found.
Data from the Cash and Counseling controlled experiment in Arkansas and New Jersey was analyzed, says Kevin J. Mahoney, PhD, one of the researchers. Dr. Mahoney is a faculty member at the Boston College Graduate School of Social Work and director of the National Resource Center for Participant-Directed Services in Boston.
"Many were dubious about letting persons with mental health disabilities manage their budgets for their home and community-based supports and services," according to Dr. Mahoney. "Our findings indicate these fears were largely unfounded." This was the case, he adds, as long as individuals had the ability to appoint a representative for the times they felt unable to manage alone, and received help from a financial management service with income tax filing, writing checks, and record keeping.
Dr. Mahoney says it was somewhat surprising that over 20% of the Cash and Counseling recipients had mental health diagnoses registered on their Medicaid claims data in the previous year.
However, Dr. Mahoney says the "big story" is that individuals with mental health diagnoses who were randomly assigned to the Cash and Counseling treatment group did much better on measures of quality of care and satisfaction than their peers who received care through traditional agencies.
These changes occurred without the need to increase costs, adds Dr. Mahoney. The individuals in the Cash & Counseling group were able to manage their own budgets, he says, with the option of hiring friends or family, and/or purchasing goods and services that helped them remain independent in the community.
The study's findings, says Dr. Mahoney, indicate that participant direction "can be a viable, productive option for persons with mental health diagnoses."
Modest demonstrations where individuals with mental health needs can manage their own budgets for mental health services are under way in Florida, Texas, Pennsylvania, Oregon, Michigan, Iowa and Maryland, reports Dr. Mahoney. "There may be a need for a large controlled experiment before doubters will feel assured that the costs are the same or less," he says.
Dr. Mahoney notes that Section 2402a of the Patient Protection and Affordable Care Act calls on the federal Department of Health and Human Services to set internal policy on participant-direction that would cut across the population groups the department serves.
"This should spur interest in the mental health community, particularly given the changes health care reform made to the 1915 (i) Medicaid state plan authority," says Dr. Mahoney. "This may be a mechanism for states to secure federal Medicaid match for some services that were previously borne by the state alone."
Contact Mr. Mahoney at (617) 552-4039 or firstname.lastname@example.org.