Sometimes, what feels like small reform — short of system overhaul — is, in practice, huge. 

Even though our long-term care system in the United States is hardly a system, the Cash and Counseling program has offered millions of low-income Americans the option to increase their independence and direct their own care in the face of chronic and debilitating illness. The Cash and Counseling reform enables people to use state funds to hire their friends and neighbors to care for them, remove home barriers to wheelchair movement, start and finish their day on their own timetables, and participate in pleasures like favorite meals that are not possible under the traditional approach featuring state-paid aides.

In short, the Cash and Counseling reform encourages “consumer-directed care.” The experience of its early beneficiaries in Arkansas, Florida and New Jersey has paved the way for what is now effectively a national option for almost all frail people on Medicaid. 

It is a radical reform, one that is programmatically innovative, but also one that depended on effective strategic communications to convey the need for reform, enroll consumers, educate their families and move policy to remove barriers to participation across the states.

My colleagues Kevin Mahoney (Boston College of Social Work), Pam Doty (U.S. Department of Health and Human Services) and Lori Rusinowitz (University of Maryland) join with me to summarize the Cash and Counseling intervention in Public Policy & Aging Report. In the paper, we explain how communications was critical to this major policy victory that is playing out in homes across the country.