INDEPENDENT CHOICES: A National Symposium on Consumer-Direction and Self-Determination for the Elderly and Persons with Disabilities. New Jersey's Experiences

William Ditto
Executive Director, New Jersey Office on Disability Services

New Jersey's Reasons for Experimenting with Cash & Counseling...

  • Demographics
    • Labor shortages now (& tomorrow)
  • Dissatisfaction
    • Consumer complaints and issues
  • Empowerment of Consumers
    • Increase of Personal Responsibility
  • Economics
    • Prudent Purchasing

Personal Preference: The New Jersey Cash & Counseling Demonstration

  • Three Major Components:
    • Marketing & Enrollment
    • Fiscal Intermediary Service Organization
    • Independent Contracted Counseling Agencies
  • The Process of Enrollment
    • Consumer Data Form (PCA Agency)
    • Verification (State Program Office)
    • Letter/Booklet/Telephone Call
    • Home Visit/Telephone Interview
    • Baseline Interview
    • Lottery
  • Show Me The Money
    • Range of Monthly Cash Grants:
      • $282 (5 Hrs/Week) to $2,262 (40 Hrs/Week)
    • Average Monthly Grant:
      • $1,300
    • NJ Medicaid PCA Hourly Rates:
      • $14.50 Weekday, $16.00 Weekend
    • 10% Administrative Deduction (covers FI & Counseling Cost)
  • Uses of Cash Grant
    • Hire Relatives/Friends
    • Hire Current Home Care Aide Privately
    • Use Agency Services as Private Pay Customer
    • Advertise and Hire Workers
    • Applicants--Washers, Microwave Ovens, etc.
    • Equipment--Comfort & convenience items
    • Supplies--not covered by NJ Medicaid
    • Purchase Services--Cleaning, Laundry, Errand
    • Home Modifications
    • Misc.--Taxi fare, out-of-pocket (not to exceed 10%)
    • Insurance, Worker Benefits, Background Check
  • Challenges for New Jersey
    • Reaching Target Audience
    • Diversity
    • Difficulty Finding Workers
    • Lack of Consumer Experience
    • Agency/Aide Sabotage

Calvin D.

Calvin is 44 years old, sustained a Brain Injury a number of years ago, has seizures and is visually impaired. He lives by himself in an apartment and is able to perform most activities of daily living independently.

  • Agency Service:
    • Calvin was authorized for 9 hours of personal care service per week. Most of the service was intended to assist him with housekeeping and meal preparation.
  • Amount of Cash Grant:
    • Calvin gets only $508.00 per month under the Personal Preference Program. Although his grant is small, Calvin has turned out to be a real "money manager."
  • Uses of Cash Grant:
    • He hired a friend who works for him 9 hours a week and is getting paid $10.00 per hour. He allocates about $25.00 each month for taxi fare so he can do his own shopping and errands. The balance of his grant he has targeted for devices that can help him be more independent. He has already obtained a "talking watch" and a new telephone with extra large numbers. He is planning to buy a microwave oven when he has saved enough in the future. He used part of the grant for insurance for his workers.
  • Result:
    • Calvin is much more independent than he was under the agency model. He has taken responsibility to budget his funds to make himself more self-sufficient.

Mr. & Mrs. R.

He is 94, deaf and has hypertension. His wife is 91 and has Parkinson's and has become confused and disoriented. They live with their daughter, who tries to work full time and also care for her parents at the same time. This family moved to the US from the Philippines.

  • Agency Service:
    • Medicaid authorized 20 hours a week of personal care services for the husband and 40 hours for the wife. The PCA agency was only able to provide about 30 hours a week in total.
  • Amount of Cash Grant:
    • The couple's cash grant is approximately $3,250 per month.
  • Uses of the Grant:
    • The daughter serves as their "representative" in the Personal Preference Program. She hired a friend from the Philippines to come and work as a "live in" and she is paid for about 60 hours a week. Other family members have been hired as "back up" staff if needed. The couple is saving $330.00 per month to build a ramp and to modify a bathroom on the first floor.
  • Result:
    • The daughter has been able to maintain her employment and the couple are receiving care from an individual who speaks their language and is familiar with their culture. The home modifications will allow the couple to make better use of their living space.

Mike L.

Mike L., age 40, sustained a Spinal Cord Injury as a result of a swimming accident while he was in his 20's and he is quadriplegic. He lives by himself in an apartment which his family made barrier-free for him after he returned home from the rehabilitation hospital. At present he is taking courses at a local college.

  • Agency Service:
    • Mike was authorized for 25 hours of personal care service under Medicaid. He was not happy with the aides, most of whom were middle-aged women ("they remind me of my mother!") and frequently he got less than the authorized service. He acknowledges that this was his own fault because of his attitude. Also, because he needs lifting and transferring, many agency aides were not able to meet his needs.
  • Amount of Cash Grant:
    • Mike's current grant is about $1,380 per month.
  • Uses of Cash Grant:
    • Mike has hired three regular employees and one back up person and is currently getting 27 hours a week of care. He pays each of his workers $10.00 per hour which has helped to ensure reliability. He also uses grant funds for medical supplies (not covered by Medicaid) and uses $15.00 each month towards nonmedical transportation costs.