Cash and Carry Programs are being piloted, demonstrated and accepted in Arkansas, Florida, Texas, New Jersey, Oregon and Colorado. HHS Secretary Tommy G. Thompson is slowly granting permissions to the states as they apply for this program.

Through the program, Medicaid recipients who also receive personal care assistance can choose to hire a family member to provide care. According to the Administration on Aging, here are the specifics of the program:

“Cash and counseling (C&C) is one of the ultimate forms of consumer direction in which consumers are given the option of receiving cash payments that they may use to purchase a variety of support services. Consumers may purchase personal care services from a home care agency, an adult day care center, a friend or a relative, or they may use the money to make home modifications or buy assistive devices that limit their future need for personal care. Along with the cash, consumers receive information, advice, and training on how to access and manage their own care.

Under the program, beneficiaries can receive the cash allowance that they receive from Medicaid to hire helpers directly – instead of relying on traditional services provided by agency workers. Beneficiaries can hire family members, friends and neighbors whom they trust — rather than allowing strangers into their homes to assist with intimate personal care tasks. This often allows beneficiaries to more readily schedule assistance when they most need it, including evenings, nights, and weekends.

In addition, program participants can spend part of their budget on home modifications or assistive technologies that Medicaid otherwise would not cover — and thereby reduce their dependence on human help. The program’s flexibility enables beneficiaries and their families to choose the combination of goods and services that best suits their particular circumstances — spending Medicaid dollars more wisely and reducing previously unmet personal assistance needs.

“Cash and counseling, or similar approaches, are being used by several European countries, including Holland, Germany, and Austria, and interest in the option is rising in this country because national and state government officials are looking for innovative and cost-effective approaches to meet the needs of a growing aged and disabled society. A number of states, including Michigan, Wisconsin, and Colorado, are currently using state funds to make C&C one component of their long-term care systems.”

The demonstration program is funded through Robert Wood Johnson Foundation and the Office of the Assistant Secretary for Planning and Evaluation (ASPE), Department of Health and Human Services.

Try to keep up with what is happening in your state to see if you qualify. You can also check with the Centers for Medicare & Medicaid at: Their toll free number is: 877-267-2323

For more information, contact:

Nat’l Program Office: Kevin J. Mahoney, Ph.D.
Program Director
University of Maryland Center on Aging
1240 HHP Building
College Park, MD 20742
(301) 405-2549

Arkansas: Suzanne Crisp, Assistant Director
Division of Aging and Adult Services
Department of Human Services
P.O. Box 1437, Slot 1412
Little Rock, AR 72203-1437
(501) 682-2441

Florida: Kerry Schoolfield, Director
Strategic Long-Term Planning
Florida Consumer-Directed Care
Department of Elder Affairs
4040 Esplanade Way
Building B, Suite 152
Tallahassee, FL 32399-7000
(904) 414-2087

New Jersey: William A.B. Ditto
Acting Assistant Director
Office of Disabled Affairs
Division of Medical Assistance and Health Services, CN-712
New Jersey Department of Human Services
Trenton, NJ 08625-0712
(609) 588-2622

New York: Ann Hallock, Project Manager
Cash and Counseling
Bureau of Program and Data Analysis
Office of Medicaid Management
New York State Department of Health
Room 2038, Corning Tower
Empire State Plaza
Albany, NY 12237
(518) 474-9265


  • Ms. Mitchell began her full-time caregiving experience in the early eighties when her husband was diagnosed with cancer. Later on she became the primary caregiver for her father, along with her mother who had become critically ill from burnout prior to her dad’s passing. In recent years, she cared for several friends with AIDS while continuing to care for her mother and actively providing support, information, referrals and resources for caregivers.

    Gail's leadership on the Internet and her success with Empowering Caregivers led her to found National Organization For Empowering Caregivers (NOFEC) INC in 2001.

    Prior to founding NOFEC, she created the iVillageHealth Chat: Empowering Caregivers, which she hosted for over 5 years. Within a month of hosting she created Empowering Caregivers: in 1999 as a resource for caregivers around the globe. Over three million visitors have frequented the website.

    She has presented at national and international care-related conferences and programs and has been a keynote speaker for many programs as well.

    Ms Mitchell has assisted thousands of caregivers online and offline in ways to empower themselves in their roles in caring for loved ones.

    For a list of clients and/or her resume, please contact

    Gail's articles have been published in many venues nationally and in Canada. Presently, she is a member of American Society on Aging and National Quality Caregivers Coalition.

    Gail has discovered that there is life after caregiving: She has become a successful ceramic artist and installation artist. She created Crystal Illumination Art to bring the transformative quality of illumination, light and color to the human experience and celebrate its ability to inspire, heal and nourish our physical, mental, emotional and spiritual well being.