Reports From the Field: Disabled Medicaid patients fare better when they direct their care

Medicaid recipients with disabilities who direct their own supportive services were significantly more satisfied and appeared to get better care than those receiving services through home care agencies, according to a demonstration project supported by the U.S. Department of Health and Human Services and the Robert Wood Johnson Foundation.

Participants in the project, which included both elderly and nonadult Medicaid recipients, were given an allowance and a high degree of flexibility and freedom to choose personal care assistants.

The study compared the outcomes of traditional care that is agency-directed with care that is directed by the recipient.

  • Reports of paid caregivers failing to complete tasks was about 60% lower in the group that directed their own care.
  • Those who directed their own care were at least as safe as those receiving agency-directed care, as reflected in reports of adverse events, health problems, and general health status.
  • Program participants were nearly 20 percentage points more likely than the control group to express satisfaction with their lives.

The study is available on-line at