A caregiver pushing a person in a wheelchair

When I joined PPL just under a year ago as President and CEO, I firmly believed that self-direction was one of the best-kept secrets in long-term care. I still believe it is – however, it is our mission as a company to share this secret – and in turn, make self-direction easier for everyone involved.

Throughout the past year, I’ve had the opportunity to have many conversations with participants (and their families) our employees, and our state and MCO clients. These conversations have revealed several common myths and misperceptions about self-directed care that I’d like to share with you.

This myth could not be farther from the truth. In fact, self-directed care was first offered by many states in the 1990s when the Robert Wood Johnson Foundation (RWJF) awarded grants to develop these “Self-Determination” programs in 19 states. These successful projects evolved further into Medicaid demonstration programs and in 2005, the Deficit Reduction Act (DRA) authorized two more avenues for states to offer a self-directed option.

Finally, in 2010, the Affordable Care Act officially and broadly authorized self-directed services for Medicaid recipients by offering a six-percentage increase in federal dollars to each state adopting the Community First Option.

I hope that by sharing these facts with you that I’ve helped debunk some of the common myths related to self-direction. But this is only the beginning.

– Vince Coppola

PPL has a deep-rooted history and more than decades of work in state self-directed care programs across the nation. Last year, PPL supported approximately 50 self-directed care programs in 22 states; and we served more than 127,000 participant and caregiver relationships – providing a valuable alternative to traditional agency-delivered care.

In fact, self-direction has several key benefits over traditional long-term care including improved quality of life (we hear this all the time from participants) as well as making healthcare more affordable.

Self-direction serves people of all ages and across all disabilities. This includes children with developmental or intellectual disabilities, persons with physical disabilities, elder care, persons with mental health issues, care for veterans, and individuals with traumatic brain injuries.

According to the AARP, 56% of adults who needed long-term services were over the age of 65 while 44% were between the ages of 18 to 64 in 2018. This insight supports recent PPL data that approximately 50% of those self-directing care are over the age of 60.

Our mission at PPL is to make self-direction worry-free and more accessible for beneficiaries and their families. Participants are never left to ‘go it alone’ in figuring out the complexities of taxes, state and federal government processes of being their own employer, when they choose to self-direct.

To take a closer look at how we make it worry-free, let’s look at the two models by which participants can choose to self-direct their care.

The first, and most popular, is the Fiscal/Employer Agent (F/EA) model, where participants are considered the employer of record (EOR). The participant sets the parameters of their own care and then selects the caregiver they trust. Then, the participant works with a Financial Management Service (FMS) vendor – like PPL – to ensure all taxes workman’s compensation policies and Medicaid-required reporting is properly filed and correct payments are made or distributed.

The second model is the Agency with Choice or Co-Employment model. With this model, a Home Health, Personal Care, or other agency is the employer of record. The agency provides a care worker for the participant, who can set the schedule and outline the duties needed. The agency is responsible for paying Federal, state and local taxes and insurance.

So you can see that with either model, the participant is supported by either PPL or the Agency in navigating the complexities of Federal, state and local taxes as well as insurance. Regardless of which model of self-direction you choose, you will be supported each step of the way journey to make this process as seamless and simple as possible.

I hope that by sharing these facts with you that I’ve helped debunk some of the common myths related to self-direction. But this is only the beginning.

To learn more about self-direction – including other common myths – I hope you’ll read our comprehensive info sheet here.

Together, we can work to ensure more Americans learn about the benefits of self-direction and how it can provide freedom of choice and control over their long-term care and support needs.

A woman pushes a teenage girl's wheelchair.

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