November 19, 2009

State Medicaid Director Letter With Additional Guidance on Medicaid Self-Directed Personal Assistance Services

The guidance applies to self-directed personal assistance services, also known as "Cash and Counseling," and to home- and community-based waiver programs when states offer the self-direction opportunity and permit participants to purchase individual-directed goods and services. Permissible purchases of goods or services that individuals may make in order to increase their independence must be related to a goal or need identified in the state-approved person-centered service plan and must be used for the purpose of increasing independence or substituting for human assistance that would otherwise be paid for by Medicaid. The purchases must also promote opportunities for community living and inclusion.