Consumer-Directed Personal Assistance Program:
This type of program uses a Medicaid-certified agency to provide support to people in their own homes. The program itself becomes the employer-of-record, which means that the support individuals are on the payrool of the agency and receive benefits and worker's compensation through the agency. The individual can hire support people of their choice through the agency program, although state regulations exclude some family members from employment as support staff, and all potential staff must go through a background check before being hired. Different levels of service exist, and these levels dictate where services may occur. All money is channeled through the agency itself, although the individual has some control over what the money will be spent for. The individual may appoint a self-directing other to assist them if they need help.
Cash and Counseling:
This type of program provides cash allowances and information services directly to the individual in need of support. Individuals determine what supports they need and where and when the supports will occur, and hire, train, and fire their own staff. Cash may also be used for other types of support needed to allow a person to stay in their own home, including home modifications and assistive devices. Counseling services provide information, advice, and training on how to manage one's own support. The money is provided directly to the individual or, if the individual chooses, through a fiscal intermediary, which means that the person may contract with an agency or individual to assist in handling tax and accounting responsibilities. The person may have a surrogate to manage the fiscal components.
MiCASSA:
MiCASSA, or Medicaid Community Services and Supports Act, would provide an option to individual eligible for nursing home or Intermediate Care Facility/Mental Retardation (ICR/MR) services which allows the individual a number of options in which to receive support in their own homes and communities. Options include vouchers, direct cash payments or a fiscal agent, or agency-delivered services. The individual is in control of attendant services and supports, including hiring, training, and firing attendants. Services and supports are designed by the individual, can ocur in home and community settings, and are based on functional need rather than on medical diagnosis. Services may include activities of daily living, instrumental activities of daily living, and health-related functions. Training and support in managing services would be available for the individual. Funding for people transitioning from segregated facilities into their own homes would be made available for expenses like rent and utility deposits, first month's rent, bedding, and basic kitchen supplies. The money would be provided directly to the person or to a fiscal intermediary who will assist them in managing supports and financial responsibilities.