All States/Territories

States’ efforts to expand consumer-directed long-term care service programs, are often hindered by challenges related to costs, staffing and organizational issues, infrastructure requirements, and resistance from stakeholders. Yet states have developed a number of successful strategies for overcoming these challenges. Their experiences offer valuable insights, guidance, and encouragement to other states considering CDS. The abstract (free) and full report (subscription required) are available.

This presentation was part of the 2007 Government and Vendor Fiscal/Employer Agent Workshop. This presentation provided an update on policies regarding self-direction, with an emphasis on those related to fiscal management activities. The session also answered some of the more frequently asked questions and explored some of the differences between section 1915(c) waiver programs and the new State Plan options for self-directed services.

This report describes the design and implementation of the Consumer-Directed Care Research Project (CDC) and draws lessons from the state's experience. The report is based primarily on in-person interviews conducted in January 2002, about 18 months after the project began enrolling beneficiaries.

The results of a survey on the interest of managed care organizations in developing a Cash & Counseling option for delivering long-term personal assistance services.

This table helps compare traditional case managers, support brokers and FMS entities and outlines them by duties and responsibilities, funding and activities for support services. This matrix was composed for a February 14, 2006 technical assistance call for Cash & Counseling grantees.

There are a number of challenges for the direct service workforce in rural areas. Review an issue brief and a recorded webinar presenting strategies that stakeholders can use to provide high-quality long-term care services and supports. States engaged in development of their direct service workforce can use these to gain knowledge of the challenges and learn about some direct service related strategies that other states and rural agencies have implemented.

The Project SEARCH High School Transition Program is a school-to-work program that takes place entirely at the workplace. The goal for each student is competitive employment. The program provides real-life work experience combined with training in employability and independent living skills to help youths with significant disabilities make successful transitions from school to productive adult life. Review an article from the DCS newsletter and accompanying pamphlets that outline this program.

Close to 200 people attended the first National F/EA Workshop held in Baltimore, MD on December 5th, 2005. Materials from the conference are now available. Review the agenda, handouts or view a presentation.

The New Freedom Commission on Mental Health identified self-directed care as one service innovation that could create a more consumer- and family oriented mental health system. Four years later, there are still fewer than 400 consumers in five states accessing self-directed care in the public mental health system. This Open Forum identifies three main barriers to explain this lack of progress. The abstract and article are available for download here.

This article describes two primary interactions between key policy implementation instruments and internal and external stakeholders that made New York's participation in CCDE not possible. This case study also provides some lessons for other states interested in developing Cash & Counseling models. The abstract for this article is available here.