News Release

Alabama First to Add Self-Directed Home-Based Services Through Its State Medicaid Plan

Alabama is the first state to receive federal approval to allow self-directed personal assistance services (PAS) as a feature of its Medicaid plan, eliminating the need for repeated requests for time-limited section 1115 demonstration programs or section 1915(c) waiver programs, HHS Secretary Mike Leavitt announced today.

“Alabama is the first to benefit from the federal law giving states an easier way to deliver better care by allowing Medicaid beneficiaries to have more control over the care they receive,” Secretary Mike Leavitt said. “When beneficiaries direct their own care, we have found, there are fewer unnecessary institutional placements, higher levels of beneficiary satisfaction, fewer unmet needs, less worker turnover and an efficient use of community services and supports.”

Under section 6087 of the Deficit Reduction Act of 2005 (DRA), states may now offer Medicaid beneficiaries the opportunity to direct their own personal care services as a feature of their state programs. 

States still must seek federal approval to offer this state plan option, but once a state plan amendment has been approved by HHS, no further permission for this added benefit is required.  Also, states must provide necessary safeguards to protect the health and welfare of participants who choose to direct their own care. States must ensure that participants have the necessary information, counseling, training and assistance to enable them to successfully manage their own care.

Alabama’s new benefit will permit participants to direct their personal care, homemaker, unskilled respite and companion services.  Furthermore, Alabama will allow participants to hire legally liable relatives to provide care and to use their service budgets to pay for items that increase their independence or substitute for human assistance.  The state will also permit participants to receive some “cash” so that goods and services can be purchased directly.

“A number of states have already expressed interest in following Alabama’s lead in taking advantage of this DRA provision permitting people to have more control over the services they receive,” said Leslie Norwalk, acting administrator of Centers for Medicare & Medicaid Services (CMS), the federal agency that regulates the Medicare, Medicaid and State Children’s Health Insurance Program.

“I look forward to working with more states to provide the most up-to-date care possible for those on Medicaid,” Norwalk said.

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Last revised: January 12, 2009