Data are based on interviews with 879 recipients of Medicaid home care services in three states- Maryland, Michigan, and Texas. In general, home care services facilitate the ability to remain at home and are rationally allocated, with the most disabled receiving the most service. Among recipients surveyed, satisfaction with services is very high. A key finding is the amount of choice and participation recipients are given in the services they receive. The three states vary significantly in the level of client choice, with Michigan allowing the most choice and Texas and Maryland permitting the least choice.
Greater choice appears to be associated with a higher level of satisfaction.
The level of choice provided to home care recipients varies by state. These differences are seen in how the respondent located his or her aide. Respondents from Michigan, who are provided more choice than those in Maryland or Texas, respectively, report that their aide is usually a relative, friend, or neighbor or someone recommended by a friend or relative. Conversely, both Maryland and Texas respondents indicate that their aide was sent or recommended by an agency, case worker, nurse, or other professional. Michigan offers more choice and participant input in helping to determine the aide s schedule.