1. Reforming State Long-Term Care Services and Supports Through Participant Direction NASHP State Health Policy Conference October 2010 Suzanne Crisp Director of Program Design and Implementation NRCPDS

2. Changes in Federal Law, Regulation, and Policy 2008 Veterans-Directed Home and Community -Based Care Program 2001 New Freedom Initiative 2006 Deficit Reduction Act 2006 Reauthorization of Older Americans Act 2007 Aging and Disability Resource Center Program 2008 Community Living Program 2

3. Prevalence of Participant Direction: 1970’s 3

4. WA AK Hawaii OR CA NV ID MT WY UT AZ CO NM TX OK KS NE SD ND MN IA MO AR LA MS TN KY IL WI MI IN WV AL GA FL SC NC VA PA NY DC MD DE NJ RI MA NH VT ME OH CT 4 Prevalence of Participant Direction: 1980’s

5. WA AK Hawaii OR CA NV ID MT WY UT AZ CO NM TX OK KS NE SD ND MN IA MO AR LA MS TN KY IL WI MI IN WV AL GA FL SC NC VA PA NY DC MD DE NJ RI MA NH VT ME OH CT 5 Prevalence of Participant Direction: 1990’s

6. 6 Prevalence of Participant Direction: 2000’s

7. Participant Direction Survey Methods Three Part Data Collection  Secondary review of existing program information State websites Medicaid waiver applications  Brief survey on program characteristics Confirm fields of information found in secondary review Obtain information on program population, structure, eligibility requirements, programmatic restrictions  Brief interview on program procedures Participant engagement, FMS, worker registries, and budget authority (if applicable)

8. (Very) Preliminary Findings 300 programs identified with some level of participant direction  Does not include VD-HCBS programs  Possible this number will drop as survey information is analyzed Majority are serving non-elder population Majority are Agency with Choice models of participant direction

9. 9 Growth of Budget Authority Programs 15 Cash & Counseling States 16 Additional States with Budget Authority Programs

10. 10 Growth of VD-HCBS Program 2008 – 7 States 2009 – Grew by 3 states for a total of 10 2010 – Expect to grow by 18 states for a total of 28