The Case for Medicaid Self-Direction: A White Paper on Research, Practice, and Policy Opportunities

SCOPE AND PURPOSE:

In recent years, self-direction has emerged as a game-changing strategy in organizing and delivering Medicaid funded services, a means of affording people with disabilities enhanced opportunities to live fulfilling lives of their own choice in local communities. Yet, despite the growth in self-directed services, many key questions remain to be answered about the most effective ways of promoting individual choice and control within a Medicaid funding environment.

To assess the current state of knowledge and pinpoint remaining gaps that need to be filled, in the fall of 2011 the National Council on Disability commissioned a study of Medicaid-funded self-directed services. This paper summarizes the key study findings, conclusions, and recommendations, and more specifically—

• Traces the history of self-directed services in the United States and its emergence and subsequent growth within the Medicaid policy arena;
• Examines the fundamental concepts that undergird a self-directed approach to organizing and delivering community-based long-term services and supports;
• Reviews the basic components of self-directed services as spelled out in federal Medicaid policy;
• Summarizes the findings and conclusions from existing studies of the cost-effectiveness of self-directed services;
• Explores the ramifications of the growing use of Medicaid managed care arrangements for the future of self-directed services and supports; and
• Recommends strategies for improving the accessibility and quality of self-directed Medicaid services and supports.