Consumer/Participant Direction

 This is Alabama's application for a Self-Directed Personal Assistance Services State Plan, used to implement their Cash & Counseling project.

This webinar on participant advocacy was presented by Bob Michaels and Leau Phillip on September 17, 2007 for the Cash & Counseling National Participant Network. The archived web cast is available here, along with the agenda, presentations, and text transcript.

Liability issues pertaining to consumer-directed personal assistant services are discussed in this report. Issues are divided into topics including consumer-worker relationships, the risk of fiscal agents, the risk of consultants, and the risk for states and government entities. The report goes onto provide options to address liability risks.

First illustrating the US workers’ compensation system, this article continues to detail worker’s compensation programs and how they function. A historical overview and the basic objective of worker’s compensation laws are also reviewed. The article ends with a discussion of issues, challenges, and promising practices.

Four presentations were given on the effects of the Cash & Counseling Original Demonstration. Topics include quality of care, worker outcomes, Medicaid costs, and implementation lessons. In addition, a link to the webcast is available.

This report focuses on creating a more balanced delivery system by expanding home and community-based services and reducing reliance on institutional care where possible is a major goal for virtually all states and the Centers for Medicare & Medicaid Services. The paper concludes by summarizing initiatives and drawing implications for the future financing of home and community-based services.

The proportion of long-term care spending that goes to institutional care has been dropping over time, from 81 percent in 1995 to 63 percent in 2005. However, there remains significant concern that many people who would prefer to receive care in the community are unable to do so because of what has been termed the ‘institutional bias’ of Medicaid. This report discusses the issues surrounding efforts underway to shift the balance toward HCBS in the state of Pennsylvania.

Looking for a way to gauge consumer satisfaction in self-direction programs? The state of Virginia Department of Medical Assistance Services (DMAS) conducts an annual Consumer-Directed Recipient Satisfaction Survey, to monitor the performance of the fiscal agent and to provide DMAS with feedback to assist in the development and implementation of quality improvement strategies. The first and second year statewide survey and findings from 2007 and 2008, are available below.

Looking for profiles of each State’s Home-and Community-Based Service (HCBS) programs? This project report covers the components of HCBS programs under multiple funding streams. It includes an overview of findings from cross-state comparisons with accompanying tables and charts and individual profiles of 48 states and Washington, DC. The findings are intended to provide states with information that can help guide their efforts to expand and improve HCBS programs.

Developing HCBS alternatives to institutional care has been a priority for many state Medicaid programs over the last three decades. While the majority of long-term care dollars still go toward institutional care, the national percentage of spending on HCBS has more than doubled from 19 percent in 1995 to 41 percent in 2007. This article presents a summary of the main trends to emerge from the latest (2006) expenditures and participant data for the three main Medicaid HCBS programs.