Understanding Medicaid Home and Community Services: A Primer, 2010 Edition. Chapter 7. Participant-directed Services and Supports


Like those without disabilities, individuals with disabilities want and expect to control their own lives. This includes having a direct say about the home and community services and supports they receive through the Medicaid program and the individuals who provide them. Virtually every state now has at least one participant direction program under Medicaid that provides options for individuals to direct and manage their own services and supports, with the assistance of family members when needed. Participant-directed services are an alternative to--and can be offered alongside--the traditional service delivery model. This chapter describes the main features of participant-directed home and community services, and the interplay between participant direction options and Medicaid policy. It focuses on services furnished through five Medicaid authorities, including Section (§)1915(c) waivers, the §1915(i) Home and Community-Based Services (HCBS) State Plan benefit, and §1915(j) Participant-Directed Personal Assistance Services. Medicaid gives states the authority to provide a full range of options for participant direction--on a continuum from less to more control and responsibility.1

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