New Mexico Gives Older and Other People With Disabilities Control and Choice Through Participant-Directed Services

Cash & Counseling Sidebar

“It’s a really big deal to be able to live on your own safely.”—Mi Via participant Jessica Guttman, who is recovering from a brain injury.

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

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 New Mexico 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.

New Mexico implemented a comprehensive participant-directed services program, called Mi Via (“my path,” “my way,” or “my road”). This sidebar covers how program staff involved potential participants and their family members in developing Mi Via, the challenges faced, and results. Many participants report that the independence and freedom they get from directing their own care, hiring their own employees, and choosing their goods and services makes them healthier and happier, and able to live with more purpose.

Self-direction and staying in the home became a real mantra for more people getting more services by living in their homes and having a healthier outcome,” said Marise McFadden, former director of the Elderly and Disability Services Division at the New Mexico Aging and Long-Term Services Department.

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