Understanding Saving and Purchase Patterns of Consumers in a Self-Directed Care Program: Unmet Needs in Traditional Medicaid Home and Community Based Services

Purpose: Self-direction in long-term care supports and services is an alternative model of delivering Medicaid services. This model offers program participants greater choice and control over services and supports they receive for their long-term care needs. Self-direction has two main aspects: employer authority and budget authority (O’Keeffe, 2009). Employer authority gives care recipients control over hiring, supervising, and even dismissing their home-care workers. Budget authority, on the other hand, allows care recipients to manage a monetary allowance, which is comparable in amount to what they would have received through the traditional Medicaid. With this flexible budget, individuals may purchase goods and services that are not covered by Medicaid to support their independence. This study focuses on the budget authority aspect, examining budget and purchase experience of people who participated in the West Virginia Medicaid Home and Community Based Services (HCBS) program. Specifically, this study aims to learn about saving and purchasing patterns of consumers in a self-directed care program.

Methods: The study sample includes individuals who participated in a self-directed care program within West Virginia’s Medicaid Aged and Disabled Waiver (ADW) Program between September 2009 and August 2011 (N=181). The exploratory nature of the study and data restrictions limit our analysis to descriptive and bivariate statistics. The following are assessed: participants’ age, disability level, goods/services requested/purchased, cost of good/service requested/purchased, estimated number of months to save for an item, service provider and/or location of purchase, and successful/unsuccessful purchasers.

Results: A total of 279 applications were filed by 181 participants. Older age was associated with severe disability service category (F=11.96, p<0.001). The most frequently requested items were related to improvement in personal functioning (n=90, 32%) (e.g. dental work, eyeglasses, hearing aids) followed by household appliances (n=70, 25%) (e.g. washer and dryer, air conditioner) and home modification (n=60, 21%) (e.g. walk-in shower, handrails). Participants’ disability levels were not significantly associated with the types of goods/services requested/purchased. Slightly more than half of the applications (56%, n=155) were planned for and required the participants to save for months before making a purchase (2-12 moths). Not surprisingly, the estimated cost of goods/services was significantly associated with the estimated number of months needed to save for an item (B=0.005, p<0.001). Three quarters of applications (76%) ended with successful purchase. There was no significant association between goal attainment and the cost of item or disability level. Lastly, a variety of shopping venues were identified. These ranged from specialty stores (e.g. local medical suppliers) to large discount stores (e.g. Sam’s Club and Wal-Mart).   

Discussion/Implications: This study was able to identify the needs of consumers in a self-directed care program along with their saving and purchase patterns. In general, findings of this study indicate that people with disabilities are interested in and able to save for the purchase of goods/services that enhance their QOL. This result is noteworthy and suggests that incorporating budget authority in long-term care delivery system may enhance the capacity of people with disabilities to better meet their needs.