Rutgers/NASHP

Although consumer direction is a growing trend in publicly supported HCBS programs across the states, we know relatively little about how this approach is implemented in the states. This national study aims to describe the role of consumer direction in publicly funded family caregiver support services and HCBS programs with a family caregiving component. This report addresses three questions with the intent of informing policy discussions.

State policy makers and consumer advocates are advancing programs and policies to support community living for all individuals. Operationalizing principles of “self direction,” “consumer direction,” or “participant direction” entails many details. This State Policy in Practice technical assistance document offers concrete information and specific state examples on ways to implement participant-directed planning and individualized budgeting.

Rutgers Center for State Health Policy/National Academy for State Health Policy Community Living Exchange Collaborative organized a site visit for Money Follows the Person grantees to learn about the Pennsylvania Community Choice Initiative. The initiative was designed to expedite access to home and community based services to avoid admission to a nursing home. The site visit was attended by grantees from California, Idaho, Michigan, Nevada, New Jersey and Texas.

A key component of consumer-direction includes methods to ensure that essential supports are provided. This State Policy in Practice technical assistance document offers a practical example from the State of South Carolina. Care Call is a system developed to help South Carolina monitor service delivery provided though South Carolina Choice, an Independence Plus waiver that enables self-direction, and its other traditional home and community-based services (HCBS) waiver programs.

Under Independence Plus Medicaid programs, states must assure that necessary safeguards have been taken to protect the health and welfare of persons receiving services. A key component of participant-direction includes individualized backup planning to ensure that essential supports are available in situations that pose a risk of harm to the participants. These examples are instructive to other states that are considering Independence Plus applications.

States seek to streamline access to HCBS in order to expedite and simplify the experience of consumers seeking services so that they receive the services they need in community settings, preventing or delaying the need for institutional care. The design of the Washington long-term support system for older adults and people with physical disabilities provides examples for other states interested in simplifying or expediting access to long-term supports.

This is the first in a series of classic information documents.

Facts about fast track, presumptive and expedited eligibility. Includes information about how can states implement it, who pays when mistakes are made and which states expedite the financial eligibility decision. Fast track and presumptive eligibility are two ways to expedite a person’s financial application for Medicaid.

Rutgers/NASHP Community Living Exchange sponsored a one-day meeting of the Vermont and Maine direct support worker associations. The purpose of the event was to provide a leadership development opportunity for the staff and volunteer members of the two association's board of directors. Sixteen people attended the meeting including nine direct support workers.

This paper synthesizes the ideas and practices of states as they seek to improve the quality of HCBS services. The purpose of this paper is: to promote the exchange of information among states regarding the use of discovery methods for HCBS services; to identify and share the various approaches that states are using to identify gaps, redundancies, strengths and weaknesses in their HCBS quality systems; to discuss ways to prioritize activities and select quality improvement activities.