Due to the lack of adequate paramedical, chore, transportation and escort services, the PC-Option programs in most states do not enable significantly disabled individuals to be full participants in their communities unless they have sufficient informal or voluntary assistance to fill in service gaps. There are several different ways in which personal assistance providers are employed. Independent or individual providers experience different conditions of employment depending upon the program and state. They may be considered self-employed or employed by the disabled recipient. On the average, agency providers and government workers receive the best wages, and government civil service workers receive the most benefits.
Independent providers are the most poorly compensated providers.
State administrators say that managerial concerns, such as liability, workers compensation, and tax withholding have shaped the structure of their programs in terms of provider type. Many states addressed these concerns by utilizing homecare agency providers, thereby shifting liability from the state to private agencies. Other states which utilize independent providers have developed different ways of dealing with withholding. Because there are advantages to using either type of provider, these issues become very complex. There are a number of ways in which states and the Federal government have tried to influence the quality of the PC-Option programs.