Exploring Patterns of Service Utilization Among Persons With Disabilities in a Consumer-Directed Care Program

Background and Purpose: The Cash and Counseling Demonstration is one of the most innovative long-term care policy experiments undertaken during the past decade. It was designed to provide a more consumer-centered alternative to the traditional models of personal assistance services to people with disabilities of all ages (Kemper, 2007). Recently, there have been innovations in the Cash and Counseling model, one being the credit union model being employed in Iowa. Through this model, a credit union serving as a Fiscal Management Service Agency (FMSA) to program participants—typically the elderly and people with disabilities—provides specialized supports such as management of a participant's public funds deposits, tracking, and distribution.

Methods: This study examines the demographic characteristics of Cash and Counseling program participants served by the credit union; explores how program participants spend their Medicaid allowances; documents the types credit union services used by Cash and Counseling program participants; list perceived barriers to use of banking services; and records the perceived effects on program participants.

The sample for this study consists of people with disabilities from Iowa currently enrolled in the credit union under the Cash and Counseling program (N=288). A program participant is defined as someone with disabilities or an elderly person who is eligible for Medicaid, needing respite, and assistive services. The analyses employed in this study are exploratory. First we calculate descriptive statistics for sample demographic characteristics. We use univariate statistics to gain an understanding of service utilization by program participants and document the type of services the credit union offers to its clientele and how these services are offered. Perceptions of barriers to service utilization are indicated. Finally, a summary of perceived effects of participating in the program is presented.

Results: Observations indicate that persons with disabilities enrolled in the program can save, albeit in small amounts, for purposes identified in their spending plans. We also note that program participants spend their Medicaid allowance on purchases in three service categories: individual-directed goods and services, self-directed personal care, and self-directed skills development. In addition, saving accounts seem to be the only service that is widely used by program participants among the specialized banking services the credit union offers to its clientele. The following were indicated as barriers to service use: Although the credit union offers an information package on services offered, this might not guarantee service use, especially in cases where consumers are not able to read and understand the information provided. The program could also benefit from a more enhanced quality assurance mechanism geared at collecting data on product usage broken down by social demographic characteristics of program participants.

Conclusion and implications: Annotations made in this study suggest that the credit union model has appeal; it provides an opportunity for people with disabilities to build savings for the purchase of goods and services that enhance their independence, functioning, and productivity. Despite this, much more needs to be done to enhance service use within this group. Consideration could be given to incorporating measures aimed at reducing barriers identified.