Consumer and Counselor Experiences in the Arkansas IndependentChoices Program. KEY GOALS AND FEATURES OF INDEPENDENTCHOICES


In February 1996, the Arkansas Department of Human Services, Division of Aging and Adult Services responded to a solicitation from RWJF for proposals to conduct “Cash and Counseling Demonstrations.” The solicitation stipulated only that demonstration programs provide an allowance, instead of the optional Medicaid PAS benefit or home- and community-based waiver program services, covering goods and services to promote independence. Arkansas hoped that its program would (1) provide an indication of the demand for a consumer-directed PAS option in Arkansas; (2) test whether consumer direction could operate efficiently in the state’s service environment; and (3) increase access to care for consumers whom the agencies did not have enough staff to serve, especially in rural areas. While Arkansas did not hope to generate savings through implementing Cash and Counseling, budget neutrality was a condition of the CMS waiver under which the demonstration operated.

IndependentChoices provided a monthly allowance in lieu of the Arkansas Medicaid PAS benefit that permitted consumers to hire personal assistance workers (including friends or family, but not spouses or those also named as IndependentChoices’ representatives) and to purchase equipment, personal care supplies, and home or vehicle modifications. For many years, eight Area Agencies on Aging (AAAs) and the state Department of Health have provided most Medicaid PAS in Arkansas. At the outset of the demonstration, most of these organizations resisted consumer direction because they were concerned about consumers’ health, safety, and vulnerability to exploitation, as well as their own potential loss of revenue. Therefore, Arkansas designed IndependentChoices in ways that would not exacerbate this antagonism (for example, by not also cashing out ElderChoices, a Medicaid waiver program for nursing-home-eligible elderly beneficiaries, in which many elderly PAS users also participated).

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