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 today by the Centers for Medicare & Medicaid Services (CMS). 

Through the rule on display today at the Federal Register, CMS requests public comment on how states could allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers rather than working with personnel employed by an agency. Beneficiaries could even hire qualified family members who may already be familiar with the individual's needs to perform personal assistance (not medical) services. 

"This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom," said Kerry Weems, CMS acting administrator.  "As health care is not simply an economic transaction, this proposal represents a fundamental shift that restores a person's ability to improve their overall health by taking greater control of his or her own decisions," Weems said.

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.  The beneficiaries also have the option to have their cash benefit allotment managed for them.

The proposal would put into place a provision of the Deficit Reduction Act of 2005 that allows states to elect a state plan option to provide care in ways that previously required "waivers" of previous Medicaid laws.  Such waivers are subject to certain budgetary requirements and are temporary in nature.

Before a state could request this change to its state plan, the state 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 must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants.  States must also train potential participants in ways to manage their budgets and assess their personal care needs.

The notice of proposed rulemaking will be published in the January 18, 2008 issue of the Federal Register.  There is a 30-day comment period.  Comments are due February 19, 2008.