The Effects of Cash and Counseling on
Children’s Service Use, Quality, and
Costs: Findings from Florida
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Florida’s Developmental Services
Program:
Leslie Foster
Stacy Dale
Randall Brown
Barbara Phillips
Jennifer Schore
Barbara Lepidus Carlson
-Serves children, aged 33-17, with
severe disabilities
-Provides a wide range of benefits
June 8, 2004
AcademyHealth Annual Research Meeting
Parents direct child’s developmental
services benefits
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Change use of goods and services
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Have fewer unmet needs; greater
satisfaction, quality of life
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No adverse effects on health or costs
3
Methods
4
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-Uses MedicaidMedicaid-certified vendors
2
Baseline Characteristics
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63% Male
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Randomly assigned children after baseline (n=1,002)
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81% White
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Interviewed parents of treatment and control group
children 9 months later (n=859)
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71% Age 12 or younger
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Examined claims for 2 followfollow-up years (n=1,002)
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68% Had collegecollege-educated parent
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66% Had unmet need for personal care
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$1124 Mean monthly allowance (treatment
group)
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Intended Effects of Consumer Directed
Care
Background
Compared outcomes for the two groups of children
(regression(regression-adjusted)
5
Help from Paid Caregivers at Followup
Treatments
Controls
6
80 %***
65 %
***Significantly different from control group at .01 (***) level.
level.
Unmet Needs at Followup
Hours of Care at Followup
Parents’ Satisfaction at Followup
Child has unmet need for:
Paid
T
Unpaid
197 ***
40 ***
T
C
237 hours
Very satisfied with paid caregiver’s schedule (%)
Help with household activities (%)
38 ***
55
Total in Past 2 Weeks
T
C
64
85 ***
Care supplies (%)
C
30
217
247 hours
26 ***
T
C
Paid caregiver ever neglected child (%)
38
T
C
Help with personal care (%)
33 ***
T
C
44
Very satisfied with child’s overall care (%)
Routine health care (%)
22 ***
T
C
7
***Significantly different from control group at .01 (***) level.
level.
8
T
C
32
9
***Significantly different from control group at .01 (***) level.
level.
Year 1
Policy Implications
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CDC/Waiver services ($)
T
C
27 ***
36
T
C
16,000 ***
12,700
18,700 ***
13,900
Contractures developed or worsened (%)
9 ***
14
T
C
10
2
T
C
4
***Significantly different from control group at .01 (***) level.
level.
6,100 **
8,300
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Total ($)
Child was injured while receiving paid care (%)
T
C
T
C
6,400 *
7,900
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29,800
28,800
From accessaccess-toto-care and quality standpoints,
Consumer Directed Care worked well
-Reduced unmet needs
-Greater satisfaction
-Fewer adverse events
Home health ($)
T
C
56 ***
Year 2
Child fell (%)
T
C
27
***Significantly different from control group at .01 (***) level.
level.
Annual Medicaid Costs at Followup
Adverse Events at Followup
12 ***
25
T
C
*,**,***Significantly different from control group at .10 (*), .05 (**)
(**) or .01 (***) level.
32,800*
30,100
12
Vigilance is needed to contain Medicaid costs