What Is Consumer-Directed Care in Home Health Care?

Medicaid offers patients (or their representatives if applicable) the ability to hire caregivers and coordinate Medicaid-authorized services through what is known as consumer-directed or self-directed services. The self-directed service delivery model, according to Medicaid.gov, is an alternative to traditionally delivered and managed services, such as an agency delivery model.

In most traditional home health care settings, an agency recruits, hires, trains, supervises, pays, and schedules the workers who come to the patient’s home. With consumer-directed services, the home health care agency facilitates payroll, taxes, and benefits, but the patients recruit, hire, train, supervise, and schedule the caregivers. The patients have more personal choice, control, and flexibility on managing what happens in their own homes, including how their self-care tasks are to be done, who is hired to provide the assistance, and what their individual schedules will be. For example, the patient can hire friends or family members to provide the services, increasing the patient’s trust and comfort level in the home care.

Who is eligible for consumer-directed services?

There are differences from program to program. Each program may have different funding mechanisms and amounts, as well as different pay rates and benefits packages. Who is and isn’t eligible to use the services differs from state to state. But generally speaking, participants must be Medicaid eligible, require personal care or private-duty nursing services, be self-directing or have a designated representative, and be willing to take control of their care and their personal assistance staff.  

What type of care can personal assistants provide?

  • Bathing, dressing, and grooming
  • Grocery shopping
  • Preparing meals and feeding
  • Escorting to appointments and social events
  • Assisting with medications
  • Performing light housekeeping
  • Entertainment (games, crafts, reading)
  • Other activities of daily living

Medicaid requires that a “supports broker/consultant/counselor” be available to each individual who elects the self-direction option to assist with coordination of services and serve as a liaison between the individual and the program.

Self-directed services are offered in more than 40 states and have grown by 20% in the wake of the COVID-19 pandemic. In fact, it’s expected that consumer-directed services will continue to grow in the future, so home health care agencies that provide personal care non-medical services under various Medicaid programs should be preparing to manage this growth. How large or small a role a home health care agency plays will vary depending on local regulations and priorities. Some will strictly perform payroll duties while others also offer advice and tools to make recruitment and management easier for consumers.

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