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News Release

Wednesday, Oct. 2, 2002

Contact: CMS Press Office
(202) 690-6145

Program Gives Eligible Residents With Disabilities Direct Control of Their Care

HHS Secretary Tommy G. Thompson today approved Arkansas' request to expand a Medicaid demonstration to allow all eligible beneficiaries with long-term disabilities to directly control their personal care services and expenses.

Under the Arkansas program, "Independent Choices," Medicaid beneficiaries who qualify for personal care services because of long-term disabilities can choose to receive a monthly allowance for those costs instead of accepting traditional agency-provided attendant care services. This provides beneficiaries and their families with greater choice and control over the supportive services needed to live at home and participate fully in community life.

"People with long-term disabilities and their families know best what services will allow them to live at home and remain active in community life," Secretary Thompson said. "This demonstration gives eligible beneficiaries in Arkansas the ability to exercise choice, control and responsibility -- a major goal of President Bush's New Freedom Initiative to promote greater independence for all Americans with disabilities."

Arkansas launched its Independent Choices program in 1998, with about 800 beneficiaries now receiving cash allowances through the demonstration. Today's approval allows Arkansas to expand the demonstration to include all of the more than 1,600 eligible beneficiaries.

Under the program, beneficiaries can receive the cash allowance that they receive from Medicaid to hire helpers directly - instead of relying on traditional services provided by agency workers. Beneficiaries can hire family members, friends and neighbors whom they trust -- rather than allowing strangers into their homes to assist with intimate personal care tasks. This often allows beneficiaries to more readily schedule assistance when they most need it, including evenings, nights, and weekends.

In addition, program participants can spend part of their budget on home modifications or assistive technologies that Medicaid otherwise would not cover -- and thereby reduce their dependence on human help. The program's flexibility enables beneficiaries and their families to choose the combination of goods and services that best suits their particular circumstances -- spending Medicaid dollars more wisely and reducing previously unmet personal assistance needs.

Preliminary results from a study of the Independent Choices program show significant positive results for those who participated in the "cash and counseling" program. For example:

  • 82 percent of "cash and counseling" participants reported their lives had improved;
  • 93 percent said that they would recommend the program to others;
  • 100 percent said that they are satisfied with worker arrangement;
  • Participants indicated that they are receiving more services for the same amount of dollars; and
  • Hospital and nursing home costs for "cash and counseling" participants were 18 percent less than those for beneficiaries receiving traditional Medicaid services.

Arkansas was the first state to implement a "cash and counseling" program. Florida, New Jersey, Oregon and Colorado also have similar Medicaid demonstration programs. In addition, HHS recently announced a new waiver template, "Independence Plus," designed to help states develop consumer-directed services. HHS' Center for Medicare & Medicaid Services (CMS) also maintains a Web site to help states share innovative practices and approaches to strengthen their community long-term support systems. More information is available at www.cms.gov/promisingpractices.

More information about the President's New Freedom Initiative and HHS' role in reducing the barriers to community living for people of all ages with disabilities is available at www.hhs.gov/newfreedom.


Note: All HHS press releases, fact sheets and other press materials are available at www.hhs.gov/news.

Last Revised: January 16, 2003