Report Released: Recommendations for Improving Self-Direction in Community HealthChoices
The Office of Long-Term Living (OLTL)'s Participant Direction Workgroup has released its report, Recommendations for Improving Self-Direction in Community HealthChoices. This workgroup was formed last year in order to develop recommendations aimed at increasing participants' use of self-direction in Community HealthChoices (CHC), which declined by 52% between June 2017 and 2022 and has continued this downward trend ever since.
Participant self-direction is an alternative to receiving personal assistance services through a home care agency. In self-direction, the participant serves as the employer and selects, hires, trains and makes employment decisions for their own direct care workers (DCWs) who provide personal assistance services. The participant – called the common law employer (CLE) in this model – is supported by a fiscal management agency that pays the workers and manages other administrative functions (e.g. verifying employability, paying and withholding taxes). In the CHC waiver, HHAeXchange through its contractor Tempus provides fiscal management services to participants. Participant CLEs are also supposed to receive assistance from their service coordinators to help manage their roles as employers.
The Participant Direction Workgroup includes participant common law employers, direct care workers, service coordinators and representatives from OLTL, HHAeXchange and Tempus, the CHC managed care organizations and Services Employees International Union, which represents some direct care workers.
The workgroup identified various challenges to successful self-direction, grouped them into themes and developed corresponding recommendations. In all, the workgroup put forth 43 recommendations, including ten key recommendations.
Most of the key recommendations, revolve around DCW recruitment and retention, including increasing DCW wages and providing benefits, increasing DCW training, paying for and supporting outreach efforts such as advertising and developing a DCW registry from which participants can recruit, establishing or adding DCWs to loan forgiveness programs, and addressing DCW onboarding and technological barriers with the Tempus. Other key recommendations focused on increasing support and training for CLEs so that they can be successful employers, including by increasing the training provided by the service coordinators who are supposed to support CLEs, and addressing communication and technological challenges with Tempus and ensuring Tempus accountability.
OLTL, Tempus and the CHC managed care organizations are primarily responsible for moving the recommendations forward. The workgroup will continue to meet quarterly for updates on the progress of the recommendations and OLTL will provide periodic updates to the Consumer and Long-Term Services and Supports Subcommittees of the Medical Assistance Advisory Committee (MAAC).
