Consumer-Directed Personal Care Programs:

Department of Veterans Affairs and Medicaid Experience

HEHS-98-50R: Published: Jan 16, 1998. Publicly Released: Jan 16, 1998.

Additional Materials:


William J. Scanlon
(202) 512-7114


Office of Public Affairs
(202) 512-4800

Pursuant to a congressional request, GAO reviewed the Department of Veterans Affairs' (VA) Aid and Attendance (A&A) program as well as selected state Medicaid programs that permit consumers to hire their own personal care attendants, focusing on whether: (1) the government might be paying twice for persons in nursing homes who also received A&A benefits; (2) there are any existing public programs that could serve as a model for Medicaid; and (3) there is sufficient knowledge about consumer-directed personal care to recommend one of these programs as a model.

GAO noted that: (1) while such programs exist, the information currently available is not sufficient to determine whether any of the existing consumer-directed personal assistance programs that allow consumers to pay or participate in paying attendants could serve as a model for Medicaid; (2) in terms of the programs in place, they tend to differ both in their mechanisms for paying attendants and in whether they monitor the use of the payments; (3) VA does not monitor the use of A&A allowance, taking the position that has no authority to tell veterans how to use the benefit; (4) state programs want to ensure that the employer taxes are paid for personal care attendants, and this can present difficulties for the consumer/employer, who must satisfy all Internal Revenue Service reporting requirements, and for the state, which generally prefers not to be the employer of record; (5) in most cases, the state or a fiscal intermediary makes payments and handles the taxes; and (6) although there has been no rigorous evaluation of any of these programs to date, the four-state Cash and Counseling Demonstration, sponsored by the Robert Wood Johnson Foundation and the Department of Health and Human Services, will produce important information on its cost-effectiveness--but not until 2001.

Oct 3, 2018

Sep 28, 2018

Sep 27, 2018

Sep 13, 2018

Sep 5, 2018

Sep 4, 2018

Jul 31, 2018

Jul 24, 2018

Jul 19, 2018

Jun 26, 2018

Looking for more? Browse all our products here