After Anna G., a 74-year-old New Jersey woman, suffered a stroke, she needed help with bathing, dressing, food shopping, laundry, meal preparation and housekeeping. Her state Medicaid plan covered the cost of a home-health care worker to provide those services, but the local agencies were short-staffed and couldn’t send helpers on the schedule Anna needed.
Anna’s daughter finally insisted her mother go to a nursing home and when Anna refused, the New Jersey Department of Human Services gave her another option: a monthly stipend to hire her own helpers. Anna paid a cousin and a neighbor to take care of her and avoided checking into a nursing facility, a move medical experts say dramatically decreases the length and quality of an elder’s life.
The solution to Anna’s problem — a non-traditional Medicaid program called Cash and Counseling — was pioneered by New Jersey, Florida and Arkansas in the late 1990s with seed grants from the U.S. Department of Health and Human Services, the Administration on Aging and The Robert Wood Johnson Foundation. The same grants were extended to12 more states — Alabama, Illinois, Iowa, Kentucky, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, Washington and West Virginia – in 2004.
Now, the Medicaid option — which allows elders to avoid tapping into the overburdened home health care industry — is spreading across the country. At least 18 more states already have plans to offer Cash and Counseling programs starting in 2008 or later, according to a new study by the Center for Health Care Strategies.
