Goal: Self-determination—an individual’s ability to make choices in all aspects of life and have those choices supported—is the goal for most individuals, including those who are aging and those with disabilities.
Problem: Texas still lacks a full self-determination model in the comprehensive community-based 1915 (c) Medicaid waiver programs. While consumer directed service delivery options provide opportunities to move toward self-determination, these options do not offer services based on a true self-determination model. According to Texas’ February 2007 Consumer Directed Services Report, the experience of states with established Consumer Directed Services (CDS) programs and Cash and Counseling demonstrations indicate that persons who self-direct their services are satisfied with services and have generally positive outcomes. Also, in states with experience, concerns about safety and the willingness of frail people to self-direct disappear. However, without direction from policymakers, the state has not implemented a self-determination model in a comprehensive Medicaid waiver that allows for more control of how one’s allocated funds are used, within guidelines.
Recommendation: The Disability Policy Consortium supports a full self-determination model within existing Medicaid waivers.
Background: Texans with disabilities and their families want their voices heard and want control over the funds allocated on their behalf. In a self-determined model the individual controls the use of the resources in their budget, determining, with the assistance of chosen allies, which services and supports they will purchase, from whom, and under what circumstances. This process allows them to make meaningful choices in how they live their lives.
Justification: A premise underlying self-direction is that the individual receiving the service is able to determine what he or she requires and can use good judgment in purchasing those services and overseeing their delivery. The principles of Self-Determination are freedom, authority, support, responsibility and confirmation. Self-determination—an individual’s ability to make choices in all aspects of life and have those choices supported—is the goal for most individuals, including those who are aging and those with disabilities. Improving consumer direction and expanding opportunities for individuals to self-direct their services with the flexibility needed, will help move us closer to that goal while increasing satisfaction, achieving positive outcomes, maintaining safety, allowing for dignity of risk, and following program guidelines. Texas’ October 2008 Consumer Direction Workgroup recommendations also support developing a self-determination pilot in two waiver programs, employing, to the maximum extent possible, a self-determination model, to be implemented in at least two locations.