A proposed rule that would allow more Medicaid beneficiaries to be in charge of their own personal assistance services, including personal care services, instead of having those services delivered by an agency, was announced Jan. 14 by the Centers for Medicare and Medicaid Services (CMS). Under the proposed rule, if a state adopts a self-directed personal assistance services state plan option, beneficiaries could receive a cash allowance to hire their own workers to help with such activities as bathing, preparing meals, household chores, and other related services that help a person to live independently. Allotments could also be used to purchase items that help foster independence, such as a wheelchair ramp or microwave oven.
Before a state can request this change to its state plan, it must have an existing personal care services benefit or be operating a home or community-based services waiver program. Furthermore, enrollment in this new state plan option is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care.
States choosing this option need to have necessary quality assurances and other safeguards in place to ensure the health and welfare of participants. States also need to train potential participants in ways to manage their budgets and assess their personal care needs. Download the proposed rule.
