Cash and Counseling

Citation: Carlson, B. L., Foster, L., Dale, S. B., & Brown, R. (2007). Effects of Cash and Counseling on personal care and well-being. Health services research, 42(1 Pt 2), 467–487.

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  • | Peer Reviewed Article


To examine how a new model of consumer-directed care changes the way that consumers with disabilities meet their personal care needs and, in turn, affects their well-being.

Study Setting

Eligible Medicaid beneficiaries in Arkansas, Florida, and New Jersey volunteered to participate in the demonstration and were randomly assigned to receive an allowance and direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group). The demonstration included elderly and nonelderly adults in all three states and children in Florida.

Data Sources

Telephone interviews administered 9 months after random assignment.


Outcomes for the treatment and control group were compared, using regression analysis to control for consumers’ baseline characteristics.

Principal Findings

Treatment group members were more likely to receive paid care, had greater satisfaction with their care, and had fewer unmet needs than control group members in nearly every state and age group. However, among the elderly in Florida, Cash and Counseling had little effect on these outcomes because so few treatment group members actually received the allowance. Within each state and age group, consumers were not more susceptible to adverse health outcomes or injuries under Cash and Counseling.


Cash and Counseling substantially improves the lives of Medicaid beneficiaries of all ages if consumers actually receive the allowance that the program offers.