How does cash and counseling affect the growth of participant-directed services?

This article shows how the innovations of the "cash and counseling" model and the widespread dissemination of positive findings from the scientifically rigorous Cash and Counseling Demonstration and Evaluation contributed to the proliferation of participant-directed services options in publicly funded home- and community-based services programs over the past decade. The cash and counseling model of participant-directed services has now diffused beyond Medicaid into Older Americans Act and Veterans Health Administration-funded programs. As the United States becomes increasingly diverse, the flexibility of participant-directed services to tailor services and supports to individual needs and preferences seems likely to stimulate further growth in participant-directed services.