Consumer/Participant Direction

Medicaid beneficiaries who have disabilities and receive personal care services (PCS) from home care agencies have little control over their care. As a result, some are dissatisfied, have unmet needs, and experience diminished quality of life. This study of Arkansas’s Cash and Counseling demonstration program, IndependentChoices, examines how consumer direction affects these aspects of care quality relative to agency-directed services

The report describes the design & implementation of Arkansas’ model of Cash & Counseling—IndependentChoices—and draws lessons from the state’s experience. The report is based on in-person interviews conducted with Arkansas state officials, IndependentChoices’ program staff, staff providing counseling and fiscal services under IndependentChoices, staff providing traditional PAS in Arkansas, and staff of advocate organizations. The summary also draw lessons for future Cash & Counseling programs.

This report describes the design and implementation of Personal Preference, New Jersey’s model of Cash and Counseling. It also draws lessons from the state’s experience. The report is based primarily on in-person interviews conducted in April 01, about 18 months after the program began enrolling beneficiaries (Nov 99).

The report presents twenty-seven case stories about the experience of adults with disabilities who receive the cash option in the IndependentChoices Program. The report focuses on how "care units," composed of consumers and/or representatives, paid workers, & counselors interacted around issues of consumer directed care. Stories were analyzed for cross-cutting topics & themes such as family context of care, the meaning of independence, & the community context of care emerged in the interviews.

This report describes South Carolina’s programs for older people and people with physical disabilities to gain access institutional and community Medicaid supports through a single access point, and have increasing opportunities to direct their own services. The report also describes how the state has been particularly innovative in using information technology to improve the quality of community supports and participants’ access to services.

This report describes the Commonwealth of Pennsylvania’s Office of Mental Retardation's efforts to implement a system-wide reform of its supports for people with mental retardation. The objective of this Transformation Project is to improve the quality of life of people who use publicly funded supports by providing them with more choices and greater control over these supports.

This document describes New Hampshire’s community based service system for people with developmental disabilities. The document provides a brief overview of the community based system and a discussion on the integration of services and programs, as well as the funding sources.

This report looks at attempts by different states to allow money to follow the person. Money Follows the Person refers to a system of flexible financing for long-term services that enables available funds to move with the individual to the most appropriate and preferred setting as the individual’s needs and preferences change.

This report describes Wyoming’s individual budgets for its Medicaid home and community-based services (HCBS) waivers for people with developmental disabilities and the statistical method used to determine individualized budgets. The report also discusses how the budgets were implemented and their impact thus far.

This report describes two models developed by Public Authorities in California to provide back-up support for consumers with disabilities who direct their own personal care. The models were developed in Alameda and San Francisco County. These counties provide examples of contrasting models for providing back-up support.