1. Self Determination in Long Term Care  Self-determination is a set of concepts and values that people with disabilities should have the freedom and support to decide how they live and participate in the community.

2. Self Determination Principles  Freedom The opportunity for the individual to plan a life with necessary supports  Authority The ability of individuals to control budgeted funds for purchasing supports  Support The arranging of resources and personnel – both formal and informal- that will assist and individual to achieve meaningful community participation  Responsibility Acceptance of valued community role and accountability for public dollars

3. Individual Plan of Services & Supports  Participants, with their allies, develop an individual plan of services and supports through the person-centered planning process  A participant’s allies are chosen by the participants and may include: family members, friends,paid staff,other professionals, and community members, etc

4. Individual Budget  An individual budget is the cost of implementing a person’s individual plan of services & supports  The individual budget is authorized by the Waiver Agent to provide a defined amount of money to implement the plan

5. Fiscal Intermediary  A Fiscal Intermediary is an independent legal entity that acts as a fiscal agent of the Waiver Agent for the purpose of assuring financial accountability for the funds in a participant’s individual budget  The Fiscal Intermediary performs essential tasks that support self-determined arrangements for participants

6. Fiscal Intermediary Functions  Functions as the employer agent for participants directly employing workers  Ensures public funds are properly managed and provider requirements for workers are met

7. Fiscal Intermediary Functions  Offers supportive services to enable participants to self-determine and direct the services and supports they need  Provide monthly budget status reports to participant and Waiver Agent and monitor the use of the budget

8. Cash & Counseling  Robert Wood Johnson Foundation sponsors three states to implement consumer-directed personal care services –Arkansas –Florida –New Jersey

9. Cash & Counseling Outcomes  Cost neutrality  Increase in services  Improved quality of life  Reduced stress on caregivers

10. Cash & Counseling in Michigan  Part of 11 states to receive funding from RJWF to implement project  In the second year of a three-year grant  Supported by the Boston College Graduate School of Social Work as the National Program Office

11. Self Determination in Long Term Care  Michigan’s Cash and Counseling  4 Pioneer Sites are initiating project –Detroit Area of Aging –Burnham Brook –Tri-County Office on Aging –UPCAP Services

12. Systems Changes to implement  Amend the current MI Choice Waiver  Reduce the assessment  Provide training and support to Pioneer Sites

13. Project Goals  MI Choice Waiver participants will be able to choose self-determination as a method for receiving supports and services on a state-wide basis

14. For More Information  Tari Muñiz, Project Coordinator 517.335.5671 munizt@michigan.gov www.cashandcounseling.org