INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. Independent Choices: Oregon

Julia Huddleston
Oregon Department of Human Services, Senior and Disabled Services Division

What is Independent Choices?

  • Financially eligible for waivered services (300% of SSI standard)
  • At risk of nursing facility placement
  • Live in 3 count cachement area
  • Demonstrated stability

Consumers arrange for care and services

Consumers manage

  • The care and services purchased
  • The employees providing the care
  • The payroll for care providers
  • The budget for services purchased

Medicaid money is paid directly to consumer

  • Prospective payment
  • Consumer must meet all obligations of being an employer

Project required Section 1115 waiver

  • Waiver effective May 1, 2001

Cognitively impaired consumers can participate with surrogate decision makers

Consumers can employ family members including spouses as caregivers or service providers

Consumers self-select into the program

Different populations

  • Younger adults--original interest
  • Elderly--as waiver process went on, more "younger old" became interested
    • In 1997, project enrollment estimated as 70% younger disabled/30% elderly
    • In 2001, enrollment estimated as 60% younger disabled/40% elderly

Surrogate decision makers

Payroll and tax preparation services

  • Consumers who must use payroll service
  • Consumers who choose to use the payroll service at their own cost
  • Pilot site differences
    • How far will the hourly wage go?
    • Cash amount based on current hourly wage
      • "$8.12 an hour is pretty good money around here."
      • Oh, clients are going to have to pay at least $11 or $12 an hour."
    • Will more family members be employed in rural areas?

Employing spouses as caregivers

  • Who will?
  • Why?