As shared by the Human Services Report Institute (HSRI):
What can states learn from NCI results about the numbers of people who self-direct their services?
In the 2016-2017 National Core Indicators™ Adult Consumer Survey (ACS), 11% of the respondents reported that they had chosen a self-directed supports option. Among states participating in the 2016-17 ACS, the proportion of respondents using the self-directed option ranged from 0% to over 50%.
Why does it matter? Self-direction is the embodiment of person-centered planning and practice. By self-directing their supports, people with intellectual and developmental disabilities (I/DD) have the opportunity to exercise more control over the services and supports they need. Often, self-direction includes the option to hire staff, to schedule and provide feedback to staff, and to manage a budget for services, including the distribution of how many units of service are used, and/or the amount paid for a specific unit of service. States have had the option to offer self-direction to individuals receiving Home and Community Based Services (HCBS) since the 1990s. When compared to people who don’t self-direct their supports, individuals who self-direct are more likely to make choices in their lives, have friends, enjoy privacy, have a job, and participate in their communities. Evaluations of the landmark Cash and Counseling program showed that participants were more satisfied with their services and used their funds in a more cost-effective manner (Brown, et al, 2007).
Questions to ask: What percentage of service recipients in your state opt for self-direction and how has this changed in recent years? What formal Medicaid authority does your state use to offer self-direction within home and community-based services? If your state does use a specific Medicaid authority, does it include support brokerage for those interested in self-directing? How does your state communicate these options to families and people with I/DD interested in self-direction? Are communication methods accessible and easily understood? What role do case managers have in educating people about self-direction, and what training do they have to carry out this role? Are individual support budgets available to self-direction participants? How do you assure that parents and young adults are introduced to self-direction as part of transition planning?