[Congressional Record Volume 149, Number 75 (Tuesday, May 20, 2003)]
[House]
[Page H4261]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                          CASH AND COUNSELING

  The SPEAKER pro tempore. Pursuant to the order of the House of 
January 7, 2003, the gentleman from Florida (Mr. Stearns) is recognized 
during morning hour debates for 5 minutes.
  Mr. STEARNS. Mr. Speaker, I am here to talk about a program called 
cash and counseling which allows flexibility for Medicaid, people who 
are poor, people who are disabled, gives them an opportunity to be 
involved and get more resources, and it is good for the Federal 
Government, too.
  In February of this year, I spoke on the floor about this Cash and 
Counseling program. It was demonstrated in Florida, Arkansas and New 
Jersey. In these demonstrations, disabled and elderly beneficiaries 
were given great latitude to direct their own support services; that 
is, they were involved themselves, and it was not just the government 
giving them a check or services.
  The national project has conducted its first evaluation of this 
program in Arkansas, and the results are in. It was reported favorably 
through the Journal of Health Affairs on March 26, 2003.
  In summary, the author concluded that, our survey of roughly 1,800 
elderly and non-elderly adults showed that relative to agency-directed 
services, as a government directing it, State directing it, Cash and 
Counseling greatly improves satisfaction and reduced most unmet needs. 
Moreover, contrary to some concerns, it did not adversely affect 
participants' health and safety, always a complaint that these elderly 
people will not get served.
  Dr. Lavizzo-Mourey, president and CEO of The Robert Wood Johnson 
Foundation, says, ``The Cash and Counseling program offers Medicaid 
consumers flexibility and a sense of control over their care.'' In The 
Robert Wood Foundation's recently released Annual Report 2002, they 
said, ``Cash and Counseling enables Medicaid beneficiaries with chronic 
illnesses and disabilities to purchase needed personal assistance 
services with cash allowances in lieu of receiving traditional agency-
delivered services. The result,'' of course, ``is greater choice and 
autonomy in obtaining the required help. Early evaluation results show 
increased access and improved satisfaction for Cash and Counseling 
clients.''
  Secretary Thompson of Health and Human Services shared, ``This 
approach gives people with disabilities more freedom and 
responsibility, in the same way that all of us want to be in charge of 
our lives and'' of course, ``our choices. It lets the individuals 
themselves decide how best to use the Medicaid dollars they are already 
entitled to. The study confirms that these Medicaid recipients make 
good choices that maintain their health and safety, even as they 
improve their convenience, satisfaction and quality of life.''
  So think about it. This program, Cash and Counseling, is part of an 
experiment that has proved successful, bringing in the actual 
beneficiaries and opportunities for choice and participation.
  We now have Consumer Directed Care which is a larger demonstration 
program. What does this mean? According to the National Association of 
State Units on Aging and the National Council on Aging, ``Consumer 
direction describes programs and services where people are given 
maximum choice and control over their care. Consumer direction may also 
be called self-determination or independent living. When people say 
they want to be independent or they want to have autonomy or self-
direction, they are talking about consumer direction. In consumer-
directed programs, consumers can choose to select, manage and dismiss 
their workers. They can decide which services to use, which workers to 
hire, and what time of day they will come. Consumer direction assumes 
that informed consumers are able to make decisions about the services 
they receive.'' Sounds good.
  Consumer-directed care has already taken off among the aging 
populations. Last Friday, the Senate's Special Committee on Aging had a 
briefing on Consumer Direction in Aging Services. State elder affairs 
leaders from Vermont and Pennsylvania and Dr. Kevin Mahoney of Boston 
College, the national director of Cash and Counseling, championed its 
success in providing an infusion of choice and freedom and independence 
to the disabled and elderly nationwide. Most States report waiting 
lists of individuals waiting to enroll in this demonstration.
  Besides in public health, many private plans are beginning to offer 
consumer-directed products. For example, in our Federal employee health 
benefit program, one group of Federal workers, the American Postal 
Workers Union, is the first to offer a consumer-directed option this 
year. On their Web site describing the option, the American Postal 
Workers Union say, We believe that people who have more control over 
how their health care dollars are spent are more satisfied customers, 
and their health plan's consumer-directed option plan is designed to 
give our employees that control.
  Besides the now-documented satisfaction, Consumer-Directed Care is 
serving to reduce costs and fraud. So, Mr. Speaker, I think we have a 
very clear case where giving choice and independence for the consumer, 
whether it is Medicaid for the poor or we should do for Medicare for 
the elderly or even in the private sector, it works much better.
  I look forward to the continued evaluation of these programs, and of 
course, I continue to see on the Federal and State level the 
championing of the Consumer-Directed Care.

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