Consumer Choices Option Today is just to give you a brief overview of this new option that we anticipate will be available this summer more in depth training will come later. As some of you may recall this option was made possible by a RWJ grant that Iowa received in the fall of 2004. At one time we were calling it developing choices empowering Iowans, we are now calling is Consumer choices option

What is Consumer Choices Option? An option that gives people who are eligible for Medicaid Home and Community Based Services (HCBS) Waivers more choice and control in managing their daily lives.

Who is eligible? All HCBS waiver consumers statewide Aids/HIV (40 consumers) Brain Injury ( 557 consumers) Elderly (7465 consumers) Ill and Handicapped (1965 consumers) Mental Retardation (8945 consumers) Physical Disabilities (445 consumers) This option will be available for the six waivers,these numbers are from November 2005 data. Please note that this does not include the children’s mental health waiver, since that is a new waiver it was decided wait until that waiver is running for a while before adding this option. Basically to add this option Iowa has to request an amendment to all six of this waivers.

Traditional service plan What is new? Traditional service plan Homemaker from provider A Home delivered meals Para-transit transportation More choice Homemaker provided by your daughter Purchase of a microwave Transportation provided by your neighbor Obviously this is just an example of what this new option will look like. Just as consumer’s individual service plans or individualized this new option will be too. But basically with this option people will convert some of their traditional services into an individual budget where they can have more choice in how their services and supports are provided. They can purchase personal care services, goods and services and other community and employment support

What remains the same? All consumers will have a service plan based on their needs All consumers will continue to work with their service worker/case manager Skilled services and other group services will continue to be provided by Medicaid providers So Nursing services, services that provide nursing oversight or a require a licensure will still be provided as they are today.

What remains the same? There will be no effect on non-waiver Medicaid services Consumers will still be offered the full array of Medicaid services they are eligible for Medicaid financial eligibility standards will remain the same

Why is Iowa offering this option? More choice is worth the effort This policy change supports the 1999 Supreme Court Olmstead Decision Evaluations conducted in states with self-direction options show: Consumers feel safer and are more satisfied when they hire their own workers Self direction expands consumers access to care Workers hired directly by consumers report higher job satisfaction DHS, the department of Elder affairs, the senior living coordinating unit and other disability advocacy groups support this movement and felt that this was worth the effort. There were three pilot states, Arkansas, New Jersey and Florida have been providing this option since the late 90’s Expands access by expanding workers.

Challenges Iowa wants to protect the integrity of the HCBS waiver programs We want to provide more choice and control without impacting the number of HCBS consumers served While offering more choice and control we want to continue to meet consumers’ needs Change is never easy, so by changing the waivers we face some challenges we face Basically we don’t want this option to mean less people receive waiver services and we know that is a concern

How do we address those challenges? This option will not cost more, nor less than traditional services This option will offer a financial management service provider to help the consumer manage their budget & Additional counseling/advice through an independent support broker To assure that consumers have help in making good choices and do not have unmet needs, consumer will work with both an independent support broker and a financial management service. The independent support broker will be hired by the consumer after completing a training and the financial management service will be a credit union

Assumptions We anticipate 10-15% of eligible consumers will choose this option If we convert to dollars authorized, it will cost more to offer this option So Consumers’ individual budget amount will be based on dollars utilized, therefore we expect it to cost the same Eventually we anticipate 10-15% will choose this option based on data from other states Services available for people to use will be based on the individual service plan, Many consumers for a variety of reasons do not use all of the services provisioned under their plan

What remains to be done? CMS approval of the HCBS waiver amendments-expected March 1st 2006 Administrative rules promulgated- May 1st 2006 Enroll Financial Management services as providers-May 1st 2006 Train and educate Independent Support Brokers, consumers and families – May 15th 2006

Consumer Choices Option will be available June 2006 starting in one DHS service area at a time.  It will be available statewide by March 2007