Consumer/Participant Direction

This second report in a series focuses on how state variation in level of experience and infrastructure to undertake large-scale transition programs can affect implementation. The authors describe differences in strategies to 1) expand transition coordination capacity 2) locate appropriate housing 3) enhance long-term supports & services 4) change Medicaid HCBS programs/policies to ensure that those who transition can remain in the community after the MFP eligibility period ends.

More than 130 policymakers, health services researchers, practitioners, and policy experts discussed the measures and evidence to examine whether the expansion of home and community-based services has produced desired outcomes (quality, choice, cost, satisfaction and safety) in the long term for older adults and persons with disabilities. The day was divided into four sessions: (quality, consumer-direction, targeting candidates, determining cost-effectiveness). View the agenda and presentations.

The key details of the partnership between the Veterans Health Administration and the Administration on Aging, created to provide consumer-directed care to veterans, are given. The document summarizes the partnership structure, standards, and target population. It also discusses the referral, follow-up, and rate setting procedures for the defined set of services and goods to be offered.

Nearly every state provides at least some funds for services for low-income older adults or people with disabilities who have too many assets to qualify for Medicaid. AARP reports on how much each state spends on both multiservice and single-service programs. It also compares funding sources, eligibility criteria, services, cost management strategies, consumer direction, and other characteristics.

STEPS teaches employer skills to people who receive in-home services through eligible programs in Oregon. Training modules go over the preparation for and completion of the hiring process. One covers communications skills and safety considerations. There are also examples of eligibility requirements, marketing materials, and referral forms.

Planning documents show how Connecticut will use a Cash & Counseling model to provide flexible service choices to keep people out of institutions. The narrative gives details such as the state’s current rebalancing status, goals and objectives, approach, challenges, service options, training and eligibility. The work plan details “Choices at Home” key tasks, lead person and time frame associated with each major objective.

The conference took place in May 2009 in North Carolina and focused on the global advancement of the principles of self-determination. Presenters spoke on topics including Medicaid reform, self-directed budgeting, self-employment; quality, education, advocacy; and youth, among others. Included here are slides from talks as well as essays by the organizer on the purpose of public funding for services and challenges facing Medicaid.

This May 2008 presentation by Mary DeRoo of the Elder Services of Merrimack Valley in Massachusetts describes the risk management system they use that manages risk while maximizing consumer choice and control.

Transitioning from school to work for youth with disabilities can be a complicated process. Sponsored by TransCen and the Johnson Scholarship Foundation, these online modules are designed to provide an overview for these young adults in transition, with a focus on work-based experiences, empowerment, health and social service linkage, family supports and interagency collaboration.

This report describes recent progress in moving state developmental disability systems using HCBS 1915 (c) waivers toward greater efficiency and equity, in the context of pressing issues in the field. It is important to note that these initiatives could be equally well applied to other Medicaid waiver populations.