Draft Rule Outlines Medicaid Proposal for Personal Assistance Care

WASHINGTON–CMS is seeking input on a proposed rule that would
allow Medicaid beneficiaries to take charge of their own personal
assistance services.

If finalized, the rule would allow Medicaid beneficiaries
needing help with activities of daily living to hire, direct, train
or fire their own personal assistance care workers. Under the
proposal, beneficiaries could even hire qualified family members to
perform the caregiver tasks.

“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 a plan option to
provide care in ways that previously required waivers of Medicaid
rules.

If a state adopts such an option, beneficiaries could receive a
cash allowance to hire workers to help with bathing, preparing
meals, household chores and related services. Allotments could also
be used to purchase items that help foster independence, like
wheelchair ramps or microwave ovens.

According to CMS, two national demonstration projects conducted
in the 1990s showed the success of personal assistance services
programs. If implemented, the program is estimated to cost $225
million between 2008 and 2012. Of that, the federal share would be
$127 million, CMS said.

Notice of the proposed rule was published Jan. 18 in the
Federal Register. Comments on the proposal are due Feb.
19.

View the proposed rule.