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Public Partnerships | PPL White Papers

Public Partnerships | PPL White Papers

"Analysis of Appendix K"

Co-authored by Suzanne Crisp and David Horvath

Self-direction is a proven approach to reducing program participants and their families' anxiety to secure safe in-home care from someone they know and trust. This paper examines self-direction and its impact on reducing the threat of the COVID-19 Pandemic. It focuses on state Appendix K submissions to the Centers for Medicare & Medicaid Services (CMS) to ensure continuity of services by requesting immediate temporary changes to §1915(c) waivers. States asked for modifications to add, expand, suspend, delay, or relax specific program policies to ensure services are accessible and that adequate staffing is available.
The positive impact of self-direction on living with the COVID-19 Pandemic is considerable.  The increased choice and control experienced by participants:

  • reduces anxiety
  • expands the workforce
  • supports safe access to services
  • encourages social distancing
  • reduces food insecurity, and
  • limits the risk of exposure to the virus
Temporary modifications states have requested and implemented could become permanent program policy changes.   States could make these options and others permanent by submitting wavier amendments to CMS.  Our future with COVID-19 is uncertain but hopeful.  However, once this pandemic is resolved, other emergencies may follow.  Making many of these CMS-approved modifications permanent changes to waiver programs and further expanding access to self-directed services could better position states for the future.