• Report

Implementing self-direction programs with flexible individual budgets: Lessons learned from the Cash and Counseling Replication States

Citation

O'Keeffe, J. (2009). Implementing self-direction programs with flexible individual budgets: Lessons learned from the Cash and Counseling Replication States. (Prepared for The Robert Wood Johnson Foundation). Chestnut Hill, MA: Cash & Counseling National Program Office.

Abstract

Self-direction is a service delivery model that gives public program participants (hereafter called
participants) greater choice and control over the long-term services and supports they need to
live at home and participate in community activities. Self-direction represents a major paradigm
shift in the delivery of publicly-funded home and community-based services (HCBS). Selfdirection
has two basic features—the employer authority and the budget authority. The employer
authority enables individuals to hire, supervise, and dismiss individual workers (e.g., personal
care attendants and homemakers). The budget authority gives participants a flexible budget to
purchase a range of goods and services to meet their needs. Many programs offer the employer
authority only, whereas virtually all programs that offer the budget authority also offer the
employer authority.