“Overall, this program has been a huge success for Kentucky. The majority of our folks have thrived. But we have a lot to learn and work on.”—Tonia Wells, manager of Kentucky’s Community Options Branch
Dates of Project: October 2004 to June 2008
Field of Work: Fostering the development of participant-directed home and community-based services for people with chronic disabilities in Kentucky
Synopsis of the Work: The Cash & Counseling national program introduced or expanded participant-directed personal assistance services for frail older adults and other people with disabilities in Kentucky and the Medicaid programs of 14 other states. Cash and counseling, now called participant direction, is an approach to long-term care personal assistance services in which the government gives people cash allowances to pay for the services and goods they feel would best meet their personal care needs and counseling about managing their services.
The program was a joint venture between the Robert Wood Johnson Foundation and the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Planning and Evaluation.
Kentucky launched the Consumer Directed Option, which allows Medicaid beneficiaries who are covered under certain waiver programs to choose how some of their services—such as personal care, respite care, and homemaking—are provided, how and when services will be provided, and who will provide the services. (Waivers granted by the Centers for Medicare & Medicaid Services let states test new or existing ways to deliver and pay for health care services in Medicaid.)
This sidebar includes challenges Kentucky faced in implementing the Consumer Directed Option and results. Through the option, the state expanded participant-directed services to 6,800 frail older adults with disabilities and people with intellectual or developmental disabilities, and expanded these services for other adults with physical disabilities and brain injuries.