Cash and Counseling

To assist states in developing and implementing home and community-based waiver programs, CMS has developed a Quality Framework. The purpose of this background memo is to help Cash and Counseling states apply the framework and incorporate the necessary waiver assurances as they develop their quality management plans for consumer directed programs. This paper offers examples that operationalize the quality framework and tables about participants: Access, Safeguards, Outcomes and Satisfaction.

The Independence Plus Initiative was established to give states expanded opportunities within Medicaid to allow for consumer direction of long-term services and supports. The consumer direction movement continues to evolve rapidly, and this calls for federal and state resources to evaluate new and changing programs. This issue paper explores the difference between IP and Cash and Counseling, the 1115 demonstration, IP and HCBS Waivers, and outlines policy implications.

This brief focuses on one consumer-direction model within the Family Care program-the Agency with Choice model-in which a \"co-employment agency\" serves as the Employer of Records and the consumer acts as the Managing Employer. In the other consumer-directed model, the consumer takes on all employer responsibilities. Slightly more than one in five Family Care members choose the co employment option, demonstrating how a managed care program can incorporate consumer direction.

Kansas operates four Medicaid waivers that allow program participants to self-direct their care. These programs permit participants to hire a worker or their choice and choose an organization to act as the Employer of Records for their worker. The programs are noteworthy because of the large number and wide variety of organizations that fulfill this function and the many different ways in which they serve their clients, providing a high level of choice to participants and their representatives.

This report assesses the experiences of personal assistance workers in the first Cash and Counseling demonstration project, Arkansas’ IndependentChoices. It describes the types and amount of care that paid workers provide, the training and supervision they receive, their working conditions, and their well-being. It also looks at how the worker-consumer relationship affects key outcomes, comparing the experiences of agency workers to those of directly hired workers.

This State Policy in Practice brief is the second in a series of reports on how states are addressing laws that regulate nursing practice to be more responsive to consumers’ preferences to live in their own communities. This brief focuses on Oregon’s policies for how nurses may collaborate with consumers in managing health maintenance activities.

In consumer-directed care, few state aging networks have been more involved than Vermont. For the past 20 years, Vermont has undertaken considerable effort developing its consumer-directed approach to health and long-term care, including significant supports to consumers and their families who choose to participate in consumer-directed programs. This report is one of 5 in a series called Case Studies from the Aging Network: Health and Social Support Systems Integration.

The report contains findings from a 2004 survey of state administrators, an opinion survey, and telephone interviews, and responds to the questions: To what extent have consumer-directed home and community based services for older people taken root across the country? What are the characteristics of these programs and how do state aging administrators view consumer-directed programs working in their state? Report findings document the scope and characteristics of consumer-directed services.

This brief describes currently available opportunities for consumer direction of care in public programs and private insurance plans, including opportunities for family caregivers to take on roles as representative decision-makers and paid caregivers. Includes recent findings from “Cash and Counseling” demonstrations and assesses prospects for expansion of consumer-directed alternatives to traditional modes of financing and service delivery.

The Community Living Exchange Collaborative At ILRU has prepared this summary notes from the National Summit on Self-Determination and Cognitive Disabilities held on April 26-28, 2004. The notes provide an overview of how to: plan for risk, manage risk, optimizing independent functioning, organizing community, natural and peer supports. Each subject is broken into the tools needed, changes needed, solutions, and training needed.