Now, the Centers for Medicare & Medicaid Services (CMS) has proposed a new rule that would give beneficiaries a cash allowance to hire, direct, and train their own personal care workers. Paid services could include help with preparing meals, household chores and other related services for independent living. You could even hire a family member to provide personal assistance (but not medical services).

The cash allowance could also be used for assistive technologies or home modifications, such as a wheelchair ramp. “This proposal would give Medicaid beneficiaries significant new freedom to determine how their personal assistance services are delivered and by whom,” said Kerry Weems, CMS acting administrator. “As health care is not simply an economic transaction, this proposal represents a fundamental shift that restores a person’s ability to improve their overall health by taking greater control of his or her own decisions.”

The proposal would put into place a provision of the Deficit Reduction Act of 2005 that allows states to elect an option to provide care in ways that previously required “waivers” of Medicaid laws. States must apply for approval of the option to be able to provide self-directed services. Enrollment in the new state plan option is voluntary and the state must also provide traditional agency-delivered services if the beneficiary wishes to discontinue self-directed care.

States choosing the option must have necessary quality assurances and other safeguards in place to assure the health and welfare of participants. States must also train potential participants in ways to manage their budgets and assess their personal care needs. The notice of proposed rulemaking was published in the January 18, 2008, issue of the Federal Register. There is a 30-day comment period. Comments are due February 19, 2008. To see the Federal Register notice, follow this link: