Consumer/Participant Direction

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 technical assistance document is the first in a series of papers that examines issues pertaining to respite services as part of the Medicaid program. By reviewing the prevalent definitions of respite in the published literature and federal documents, we seek a consistent view of respite services that can be used in the development of administrative policies to support respite for Medicaid HCBS beneficiaries and their informal caregivers.

The Compendium contains basic information about each of the Real Choice Systems Change Grantees. The Compendium will help you learn more about how these grants will be used to allow more people of all ages with a disability or long term illness to live and participate in their communities. Real Choice Systems Change Grantees will also find the Compendium useful to identify other Grantees with similar goals and activities. The fourth edition of the Compendium replaces all previous editions.

The Real Choice Systems Change grant was awarded in 2002 to the Connecticut Department of Social Services. The project has two primary goals: 1) To build the capacity within the state of Connecticut to support informed decision making, independent living, and a meaningful quality of life for persons with disabilities across the life span. 2) To assist three communities in Connecticut to become models of support for opportunities and choices for persons with disabilities across the lifespan. 

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.

The “Housing Search Guide” was developed to assist professionals who have a role in “relocation” of people with disabilities from nursing facilities to community living arrangements with appropriate services and supports. The Guide was developed by staff of the Texas Independent Living Partnership, a program of ARCIL, Inc. funded by the federal Centers for Medicare & Medicaid Services under the “Real Choice Systems Change” program.

The purpose of this project is to promote transition from an institution-based to a community-based system, in keeping with the goals of the federal New Freedom Initiative. This document summarized the policy recommendations of the Texas Independent Living Partnership over the three-year grant period, providing a resource to Texas state agencies, Centers for Independent Living, and other interested parties for ongoing systems advocacy and program development.