Consumers choosing to self-direct must then decide between two models. Under one model, all consumers must agree to participate in the most extensive consumer-directed program we reviewed, which requires clients to be responsible for training and developing job descriptions for their attendants as well as for performing actual payroll management functions. These consumers receive a voucher check twice a month from the state based on time sheets that they submitted. Personal attendants are hired by the consumers and trained on the job by the consumers to assist with daily activities. Under the second model, consumers may choose between more limited self-direction and agency provision of service.
Maine limits eligibility to individuals with chronic or permanent disabilities.
State officials' concerns center on states' ability to limit participation in their waiver programs. These providers are paid directly by a state agency, and, thus, consumers have minimal involvement in the payroll process. However, consumers of Medicaid in-home care do verify that the authorized hours of work were performed by signing workers' time sheets. In Oregon, case managers play a significant role in ensuring a successful community-based placement. Consumers work with case managers to obtain the set of services that best meets their functional needs.