Consumer-Directed Models of Personal Care: Lessons from Medicaid

In this article, the authors compare and contrast alternative approaches to administering programs, financed under the Medicaid personal care services (PCS) optional benefit, that make attendant services available to low-income elderly and disabled persons in need of help with daily living tasks. The analyses address the following issues: (1) By how much do State Medicaid PCS programs vary in terms of their administrative features that promote greater consumer choice and control or, conversely, in their emphasis on professional oversight and accountability? (2) To what extent have program administrators actively fostered consumer-directed care models? (3) What are the decision-making trade-offs in terms of Medicaid PCS costs per hour of attendant service, coverage for high-need clients, perceived risks to quality, or other liability concerns associated with consumer direction versus professional management of attendant services? (4) To what extent do clients report having greater choice and control over attendant services in some States' Medicaid PCS programs as compared to others? (5) Does greater client choice and control result in higher client satisfaction with attendant services? (The Milbank Quarterly, Volume 74, Number 3, pp.377-409) [30 PDF pages]