The Effects of Cash and Counseling on
Children’s 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

Florida’s Developmental Services
Program:
-Serves children, aged 3-17, with severe disabilities
-Provides a wide range of benefits
-Uses Medicaid-certified vendors

3
Intended Effects of Consumer Directed
Care

Parents direct child’s 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

4
Methods
 Randomly assigned children after baseline (n=1,002)
 Interviewed parents of treatment and control group children 9 months later (n=859)
 Examined claims for 2 follow-up years (n=1,002)
 Compared outcomes for the two groups of children
(regression-adjusted)

5
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)

Help from Paid Caregivers at Followup
Treatments
Controls 65 %
80 %***
6
***Significantly different from control group at .01 (***) level.

Hours of Care at Followup
T
Paid Unpaid
40 *** 197 ***
C 30 217
Total in Past 2 Weeks
237 hours
247 hours
7 ***Significantly different from control group at .01 (***) level.

Unmet Needs at Followup
Child has unmet need for:
T
C
Help with household activities (%)
38 ***
55
T
C
Care supplies (%)
26 ***
38
Help with personal care (%)
T
C
33
T
C
Routine health care (%)
22 ***
32
***
44
8 ***Significantly different from control group at .01 (***) level.

Parents’ Satisfaction at Followup
T
C
Very satisfied with paid caregiver’s schedule (%)
85 ***
64
T
C
Paid caregiver ever neglected child (%)
12 ***
25
T
C
Very satisfied with child’s overall care (%)
56 ***
27
9 ***Significantly different from control group at .01 (***) level.

Adverse Events at Followup
T
C
Child fell (%)
27 ***
36
T
C
Contractures developed or worsened (%)
9 ***
14
T
C
Child was injured while receiving paid care (%)
2
4
10 ***Significantly different from control group at .01 (***) level.

Annual Medicaid Costs at Followup
T
C
Year 1
16,000
12,700
***
Year 2
CDC/Waiver services ($)
T
C
18,700
13,900
T
C
6,400 *
7,900
Home health ($)
T
C
6,100 **
8,300
Total ($)
T
C
29,800
28,800
T
C
11 * , ** , ***Significantly different from control group at .10 (*), .05 (**) or .01 (***) level.
***
32,800 *
30,100

12
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