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What Does Research Tell Us About Self-Determination and Self Direction Services?. International Conference on Self-Determination Kevin J. Mahoney May 4, 2009. Receiving Paid Assistance at 9 Months. Non-Elderly Adults. Percent. Children. Elderly Adults. **. **. **. **. **. **. - PowerPoint PPT Presentation
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What Does Research Tell Us About Self-Determination and Self Direction Services? International Conference
on Self-Determination
Kevin J. MahoneyMay 4, 2009
2
Receiving Paid Assistance at 9 Months
95
76
92 94 94 94
80
68 64
79 79
65
91
82
0
20
40
60
80
100
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
Very Satisfied with Overall Care Arrangements
68
505657
68
52
71
27
54
42
35 37
4748
0
10
20
30
40
50
60
70
80 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
Had an Unmet Need for Help with Personal Care
41
34
55
37
47
58
4543
3633
4446
2726
0
10
20
30
40
50
60Non-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
Contractures Developed or Worsened
26
14
2022
27
13
9
2018
16
9
2528
25
0
10
20
30
40 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
Very Satisfied with Way Spending Life These Days
43
64
38
56
36
4752
29
23
50
21
37
2825
0
20
40
60
80 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
Informal Caregivers Very Satisfied with Overall Care
*,**,*** Significantly different from control group at .10 (*), .05 (**), or .01 (***) level.
4852
4243
30 32
22
0
20
40
60
PercentAdults Children
T T T TC C C C
AR FL NJ FL
***
******
***
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
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
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
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
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
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