The future of Cash and Counseling: the framers' view

Objective. This paper reflects on the progress of the original Cash and Counseling states, and shows how this model has spread, how it has evolved over time, and what is left to improve. It then discusses the generalizability of the Cash and Counseling approach beyond long-term care and ventures some thoughts on what still needs to be learned. Finally, this paper suggests some of the contingencies that could affect the diffusion of this innovation. Data Sources/Study Setting. Drawing from ten years of experiences with the fifteen Cash and Counseling states, plus their analyses of current trends and future opportunities and threats, the framers of the Cash and Counseling model reflect on future directions. Study Design. This paper is essentially a policy-driven analysis of how the Cash and Counseling model has been sustained and disseminated, how it is likely to develop, and what still needs to be learned. Principal Findings. The basic Cash and Counseling model appears adaptable to different state environments and populations, but that hypothesis will be severely tested as more and more states seek to replicate. As one step to promote flexibility while capturing and preserving the essence of the model that led to such promising research results, the Cash & Counseling National Program Office developed a "Vision Statement". Conclusions. The Cash and Counseling approach is not for everyone, but it is clearly a choice many participants desire. Its development merits monitoring. Key Words. Consumer direction, federal and state policy, cash and counseling
The Supreme Court's 1999 Olmstead decision made it clear that state long-term care systems must provide a continuum of services that allows people to live where and how they want. [...]