The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that would allow more Medicaid beneficiaries to hire their own personal care workers rather than work with agency personnel. If a state adopted the option, beneficiaries could receive a cash allowance to hire their own personal care workers and purchase items that foster independence, such as wheelchair ramps or microwave ovens. Enrollment would be voluntary and the state would have to provide agency-delivered services if the beneficiary wished to discontinue self-directed care. The rule would implement a provision of the Deficit Reduction Act of 2005 that allows states to provide care in ways that previously required a waiver.

The proposed rule is available in the Federal Register at http://www.access.gpo.gov/su_docs/fedreg/a080118c.html.