	The North Carolina Department of Health and Human Services
	The Office of Long-Term Services and Supports

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Consumer Choice

Across the United States, as well as in North Carolina, human services systems change is occurring in a way that supports consumers' independence, choice, and dignity and incorporates more flexibility in services. North Carolina is developing more options for consumers who choose to manage some aspects of their home and community-based services. This is known by such terms as "consumer-direction," "self-direction" or "independent living."

Background

1980's--the North Carolina Division of Vocational Rehabilitation Services' Independent Living Program began a personal care program that allows consumers to hire, train, and supervise his or her personal care attendant(s).
A similar program is operated through the North Carolina Division of Services for the Blind.
In 2001, through a Real Choice Systems Change Grant from the Centers for Medicare & Medicaid Services (CMS), the N.C Department of Health and Human Services provided "seed" money to pilot test the concept of consumer direction in Duplin and Cabarrus Counties. The Division of Medical Assistance developed a Medicaid waiver program (CAP-Choice), which was used by the pilots. [Note: Since that time, two additional counties have started consumer-directed services - Surry and Forsyth counties.]
The Cabarrus Department of Aging joined with the Cabarrus CAP-Choice pilot to test consumer direction utilizing Home and Community Care Block Grant (HCCBG) and other funds.
Two projects through the Division of Aging and Adult Services - Project C.A.R.E. and the Special Assistance In-Home services - have some limited opportunities for consumer direction.
In 2002, the Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMHDDSAS) used a CMS grant for Community Integrated Personal Assistance Services and Supports (C-PASS) to develop materials to inform people about consumer direction.

Current Programs and Initiatives

The Department of Health and Human Services is continuing to expand consumer-directed programs through the Centers for Medicare & Medicaid Services' Systems Transformation Grant and other funding. Examples of projects include:

Revision of the CAP-DA Medicaid Waiver to expand consumer direction options statewide incrementally.

Plans to increase the number of counties in which "consumer-directed" services are available using HCCBG and other funding.

The Office of Long-Term Services and Supports is assisting divisions and offices providing long-term services and supports so that they will be successful in offering consumer-directed options, such as creating training tools, offering training and resolving issues that arise as programs are implemented.

Last Updated April 16, 2008