February 19, 2003
COLORADO'S CONSUMER DIRECTED ATTENDANT SUPPORT PROGRAM
By: Helga Niesz, Principal Analyst
You asked about Colorado's new Consumer Directed Attendant Support Program (CDAS).
CDAS is a five-year 1115 Medicaid demonstration waiver pilot program, administered by the Colorado Department of Health Care Policy and Financing. It is a “consumer-directed” personal care attendant (PCA) program that allows up to 150 eligible elderly or disabled people to act as employers and hire and train attendants to help them with the activities of daily living, instead of receiving services through a home health care agency. Participants must be Medicaid eligible, have received Medicaid home health care for the past 12 months, and complete a training course to learn how to direct their own care (CRS § 26-4-903).
The consumer acts as the employer and undertakes the responsibility for arranging his own care. He can hire anyone as his PCA, including family members or a spouse. The state requires no specific training for the PCAs; it leaves decisions about training up to the consumer. But the consumer must undergo a course in “attendant support management training” to learn how to hire, train, and supervise the PCAs. Case managers help the consumer develop a care plan.
Finances are handled by a fiscal intermediary known as an intermediary service organization (ISO). The ISO receives an individual allocation for each consumer based on what Medicaid would otherwise spend for home care and, at the consumer's direction, pays the PCA a negotiated rate, does the paperwork, and withholds appropriate taxes. The ISO also conducts background checks on the PCA. If the consumer uses less money than home health care would have cost, half the savings go to the state. The other half goes into a special fund and the consumer can apply to use these funds to cover additional services or equipment needed to promote independence. If the program administrator approves, the ISO pays for the services or equipment.
The program received federal approval in August 2001 after four years in development and began its first enrollment period in late 2002. There are currently six people fully enrolled and receiving services. Another 47 have been determined eligible and are undergoing training and developing care plans. At the end of January 2003, the program began another enrollment period, which resulted in about another 25 people being determined preliminarily eligible.
More information is available on the Colorado Department of Health Care Policy and Financing website, which also contains a training manual (aimed at the consumer of services, not the attendant):
A recent article on Colorado's program appeared in the National Conference of State Legislatures' Promising Practices August 2002 at: http://www.ncsl.org/programs/health/autonomy.pdf.