1. 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. 2 Background Florida’s Developmental Services Program: Florida’s Developmental Services Program: -Serves children, aged 3-17, with severe disabilities -Serves children, aged 3-17, with severe disabilities -Provides a wide range of benefits -Provides a wide range of benefits -Uses Medicaid-certified vendors -Uses Medicaid-certified vendors

3. 3 Intended Effects of Consumer Directed Care Parents direct child’s developmental services benefits Parents direct child’s developmental services benefits Change use of goods and services Change use of goods and services Have fewer unmet needs; greater satisfaction, quality of life Have fewer unmet needs; greater satisfaction, quality of life No adverse effects on health or costs No adverse effects on health or costs

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

5. 5 Baseline Characteristics 63% Male 63% Male 81% White 81% White 71% Age 12 or younger 71% Age 12 or younger 68% Had college-educated parent 68% Had college-educated parent 66% Had unmet need for personal care 66% Had unmet need for personal care $1124 Mean monthly allowance (treatment group) $1124 Mean monthly allowance (treatment group)

6. 6 Help from Paid Caregivers at Followup ***Significantly different from control group at.01 (***) level. %*** TreatmentsControls %

7. 7 Hours of Care at Followup ***Significantly different from control group at.01 (***) level. *** TC 237 hours 247 hours PaidUnpaid Total in Past 2 Weeks ***

8. 8 Unmet Needs at Followup Child has unmet need for: Care supplies (%) Help with personal care (%) ***Significantly different from control group at.01 (***) level. *** TC TC TC Routine health care (%) *** TC Help with household activities (%)

9. 9 Parents’ Satisfaction at Followup Very satisfied with paid caregiver’s schedule (%) Paid caregiver ever neglected child (%) Very satisfied with child’s overall care (%) ***Significantly different from control group at.01 (***) level. *** TC TC TC

10. 10 Adverse Events at Followup Child fell (%) Contractures developed or worsened (%) Child was injured while receiving paid care (%) ***Significantly different from control group at.01 (***) level. *** TC TC TC

11. 11 Annual Medicaid Costs at Followup CDC/Waiver services ($) Home health ($) *, **, ***Significantly different from control group at.10 (*),.05 (**) or.01 (***) level. Year 1 Year 2 *** TC TC TC TC * Total ($) TC *** * ** TC

12. 12 Policy Implications From access-to-care and quality standpoints, Consumer Directed Care worked well From access-to-care and quality standpoints, Consumer Directed Care worked well -Reduced unmet needs -Greater satisfaction -Greater satisfaction -Fewer adverse events Vigilance is needed to contain Medicaid costs Vigilance is needed to contain Medicaid costs