The Effects of Cash and Counseling on Childrens Service Use, Quality, and Costs: Findings from Flori

1
The Effects of Cash and Counseling on Childrens
Service Use, Quality, and Costs Findings from
Florida

• Leslie Foster
• Stacy Dale
• Randall Brown
• Barbara Phillips
• Jennifer Schore
• Barbara Lepidus Carlson

June 8, 2004 AcademyHealth Annual Research Meeting
2
Background

• Floridas Developmental Services Program
• -Serves children, aged 3-17, with severe
  disabilities
• -Provides a wide range of benefits
• -Uses Medicaid-certified vendors

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Intended Effects of Consumer Directed Care

• Parents direct childs developmental services
  benefits
• Change use of goods and services
• Have fewer unmet needs greater satisfaction,
  quality of life
• No adverse effects on health or costs

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Methods

• Randomly assigned children after baseline
  (n1,002)
• Interviewed parents of treatment and control
  group children 9 months later (n859)
• Examined claims for 2 follow-up years (n1,002)
• Compared outcomes for the two groups of children
  (regression-adjusted)

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Baseline Characteristics

• 63 Male
• 81 White
• 71 Age 12 or younger
• 68 Had college-educated parent
• 66 Had unmet need for personal care
• 1124 Mean monthly allowance (treatment group)

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Help from Paid Caregivers at Followup
Treatments Controls





Significantly different from control group at
.01 () level.
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Hours of Care at Followup
Paid Unpaid Total in Past 2 Weeks
T C
237 hours


247 hours
Significantly different from control group at
.01 () level.
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Unmet Needs at Followup
Child has unmet need for
Help with household activities ()

T C
Care supplies ()

T C
Help with personal care ()

T C
Routine health care ()

T C
Significantly different from control group at
.01 () level.
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Parents Satisfaction at Followup
Very satisfied with paid caregivers schedule ()
T C

Paid caregiver ever neglected child ()

T C
Very satisfied with childs overall care ()
T C

Significantly different from control group at
.01 () level.
10
Adverse Events at Followup
Child fell ()

T C
Contractures developed or worsened ()

T C
Child was injured while receiving paid care ()
T C
Significantly different from control group at
.01 () level.
11
Annual Medicaid Costs at Followup
Year 1
Year 2
CDC/Waiver services ()
T C

T C

Home health ()

T C

T C
Total ()

T C
T C
,,Significantly different from control
group at .10 (), .05 () or .01 () level.
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Policy Implications

• From access-to-care and quality standpoints,
  Consumer Directed Care worked well
• -Reduced unmet needs
• -Greater satisfaction
• -Fewer adverse events
• Vigilance is needed to contain Medicaid costs