1. What Does Research Tell Us About Self-Determination and Self Direction Services? International Conference on Self-Determination Kevin J. Mahoney May 4, 2009

2. 2 Receiving Paid Assistance at 9 Months Non-Elderly Adults *, ** Significantly different from control group at.05,.01 level, respectively. Percent T C AR Elderly Adults Children T C FL T C NJ T C AR T C FL T C NJ T C FL **

3. 3 Very Satisfied with Overall Care Arrangements Non-Elderly Adults *, ** Significantly different from control group at.05,.01 level, respectively. Percent T C AR Elderly Adults Children T C FL T C NJ T C AR T C FL T C NJ T C FL **

4. 4 Had an Unmet Need for Help with Personal Care Non-Elderly Adults *, ** Significantly different from control group at.05,.01 level, respectively. Percent T C AR Elderly Adults Children T C FL T C NJ T C AR T C FL T C NJ T C FL ** * *

5. 5 Contractures Developed or Worsened Non-Elderly Adults *, ** Significantly different from control group at.05,.01 level, respectively. Percent T C AR Elderly Adults Children T C FL T C NJ T C AR T C FL T C NJ T C FL ** * *

6. 6 Very Satisfied with Way Spending Life These Days Non-Elderly Adults *, ** Significantly different from control group at.05,.01 level, respectively. Percent T C AR Elderly Adults Children T C FL T C NJ T C AR T C FL T C NJ T C FL ** *

7. 7 Informal Caregivers Very Satisfied with Overall Care *, **, *** Significantly different from control group at.10 (*),.05 (**), or.01 (***) level. Percent Adults Children TT T T C C C C ARFL NJ FL ***

8. 8 Effects on Medicaid PCS/HCBS Expenditures—Year 1 Significantly higher for treatment group in each state In Arkansas and New Jersey, mainly because control group received substantially less care than authorized In Florida, mainly because children and adults with developmental disabilities got larger benefit increases after assigned to treatment group

9. 9 Effects on non-PCS Medicaid Expenditures Other Medicaid costs moderately lower for treatment group in each age group in all three states The best example:  In Arkansas, compared to control group, treatment group had 40% fewer admissions to nursing facilities in second year

10. 10 Effect on Total Medicaid Costs In Arkansas, no significant difference by end of year two  Reductions in nursing facilities and other waiver costs off-set increase in personal care costs In New Jersey and Florida, costs up 8-12%, but states learned how to control costs Higher costs in Arkansas and New Jersey due to failure of traditional system

11. 11 Lessons Learned from the Replication States Implementing Self-Direction Programs with Flexible Individual Budgets: Lessons Learned from the Cash & Counseling Replication States Available on the Cash & Counseling homepage: www.cashandcounseling.org www.cashandcounseling.org

12. 12 Final Results from Arkansas’ 10 Years of Experience Under a 1115 Waiver Cost are 13.8% higher than if agency delivered  $6,728,320.87, including administrative cost of $2,874,400.00) However, 89.4% more care was delivered through the consumer-directed model If the agency were to deliver this same quantity of services, it would have increased the agency personal care expenditures by $33,935,955.31