Dignity and Respect

All people have the right to be treated with dignity and respect. All people have the right to the “dignity of risk” and to “know the whole story.” Many of our greatest lessons are learned when we make choices and follow our decisions. The network of support makes risk possible by providing safety and supporting growth.

Choice and Control

All people have the right to choose what they will do with their lives. When people need help, friends and family can be most effective in assisting them to broaden their experiences and to exercise their right to make their own choices. Services and supports need to respond to what Iowans with disabilities and older Iowans actually want and need to be successful.

Relationships

Relationships provide everyone with strength, support, safety and security. It is essential that relationships are maintained and expanded. Paid services, through a traditional provider, can isolate people. The development of new relationships is crucial.

Giving and Community

Everyone has the ability to give to his or her community in a meaningful way. When we give of ourselves, we feel a sense of belonging. Community membership includes having your own home (where you control who comes through the door), a job, involvement in your community and making a difference in the lives of others. To be truly independent is to be able to recognize our strengths and weaknesses, to know when to seek help and rely on the assistance of others, but also to know when to show leadership.

Dreaming and Planning

All people have hopes and dreams for the future as well as goals they want to achieve.
A supportive team helps people identify these dreams, and then creates a plan to prioritize
and realize these dreams.

Personal and Fiscal Responsibility

When there is control over how funds get spent, there is also responsibility to live within a budget. Making things happen does not always require money. To find the best quality for the most reasonable price, people are able to purchase in and out of the service system.

The Role of Professionals

Professionals become partners with the people who hire them. They assist people in understanding what their choices are and realizing their dreams.

Choice Has Limits

Public funds will not be used to support choices that are illegal or harmful to the person or others. The choices must be available to all. Public funds should get a “return on investment” and should not be given out without expectations.

Self-Determination is Honored

Self-determination means becoming more creative in helping people find ways to learn decision-making and manage their actions. Self-determination is not an excuse for abandoning someone in an unsafe situation on the grounds that he or she “chose” it. There are limits to the level of risk society will allow people to take with their own lives and physical well-being; however, it is not right to limit “choices” to either excessive restrictions or no support at all.

Whatever It Takes

There is a commitment to help people determine their dreams, respect their dreams, and help their dreams come true. An answer of “No, we can’t” is replaced by “How can we make this happen?”

Having control and making your own decisions is powerful! At times, though, everyone needs input and support about different parts of their lives.

Many of the things you need and want in life will cost money. You will need to buy some of the help you need. You can choose the people who will help you meet your life goals. When your helpers are working for you as part of your support team, you know everyone has the same goals. Those goals are based on things important to you. Other goals you have will cost little or no money. Determining how money is spent is especially important when there isn’t enough money to go around for everyone who needs it.

If you are going to make your own choices and want more control of your own life, you will need tools!

Using Medicaid funds carefully helps people gain control of their future.
The Consumer Choices Option offers three tools to help you make important
decisions about your life and to support you with your follow-up actions:

1. Independent Support Broker services
2. An Individual Budget
3. Financial Management Services

These tools are meant to make it easier for you to gain control of where you live and with who, become a thriving member of your community, engage in long-term relationships as well as choose, get and keep a job.

C hapter 2: Getting Started

Making choices can lead to accomplishing your dreams!

How do people with disabilities or older Iowans get help to buy or direct their own services through the Consumer Choices Option?

1. If you are not currently using Home- and Community-Based Waiver Services (HCBS), you can call your local Department of Human Services (DHS) office or your local County Central Point of Coordination (CPC) Coordinator to determine your eligibility for HCBS funding-your gateway to the Consumer Choices Option.
2. Iowa Medicaid Enterprise Member Services can help you find your local DHS office number or local CPC Coordinator. Iowa Medicaid Enterprise Member Services can be reached by calling 1-800-338-8366 (toll free) or at 515-725-1003 in the local Des Moines area. They are there to help you to get services and explain how services can be provided. You may also check their website at http://www.ime.state.ia.us. You can also find the telephone numbers for your local DHS office or County CPC in your phone book.
3. If you are already using Home- and Community-Based Services, a case manager/ service worker will meet with you, your family and/or your advocates.
4. Once you are determined eligible for HCBS and decide you want the Consumer Choices Option, your case manager/service worker will work with you to determine how much money you can spend each month based on your needs. The case manager/service worker will use information from your service plan and review your history using services to determine your monthly allowance.

Where does your monthly allowance come from?

The Iowa Department of Human Services (DHS) receives money for services from: the State of Iowa, the federal government and the local government. There are many rules and regulations connected with different funding sources.

C hapter 3: Choosing an Independent Support Broker

Independent Support Broker

A person, who provides information, helps you develop your Individual Budget, helps you get needed supports within that budget, and provides ongoing monitoring of your Individual Budget.

The first step to direct your own services is choosing an Independent Support Broker. Choosing an Independent Support Broker is important and can be a big job. Sometimes it is easier to make important decisions when you have help. It may help to have a relative, advocate, or friend who you know will honor your preferences to lend you a hand in figuring out what each Independent Support Broker applicant has

to offer. Your Independent Support Broker will be required to successfully complete a training approved by the Department of Human Services

Independent Support Brokers will be able to provide you and your family with information and ideas about where to look for help. The better your Independent Support Broker knows you and the support you want and need, the better service they can provide.

If you cannot think of anyone to hire as your Independent Support Broker, your case manager/service worker can help you contact available brokers and can answer your questions about the Consumer Choices Option. Your assigned case manager/service worker may be able to help you schedule interviews and prepare to interview Independent Support Brokers.

Once hired, your Independent Support Broker will work with you to find the help you need. Your Independent Support Broker will be able to work up to six hours to help you develop your first Individual Budget. Once your Individual Budget is developed, your Independent Support Broker will be able to work up to 20 hours a year. Your Independent Support Broker works for you. If you feel your Independent Support Broker does not meet your needs, you can choose a different one.

An Independent Support Broker needs the skills to...

• Develop your Individual Budget
• Arrange and coordinate supports in a way that fits your Individual Budget and stays within your monthly allowance
• Help prioritize needs and wishes so you receive the support most important to you
• Explore community resources

• Assist in connecting you to your community
• Monitor your Individual Budget and provide support for turning time cards in
  accurately and on time
  
• Represent you when dealing with service providers and employees
• Create options for additional support when needed
• Develop informal as well as formal supports
• Be a good listener and advocate
• Be a team player who can work with people, families, and support providers
• Diplomatically represent different viewpoints while honoring your priorities and
  following your wishes
  
• Resolve conflicts respectfully

Things to keep in mind before hiring an Independent Support Broker:

• An Independent Support Broker can be a friend, neighbor, pastor, or other
  interested person.
  A broker can also be a full-time professional Independent Support Broker.
  
• If you are under 18 years old, an Independent Support Broker cannot be your
  parent/guardian.
  
• If you are over 18 years of age, an Independent Support Broker may not be your
  guardian, spouse, or legal representative.
  
• An Independent Support Broker cannot be an employee of an agency that provides
  direct services or supports to you.
  
• An Independent Support Broker cannot get paid to provide other services to you.
• An Independent Support Broker must have knowledge of local services and supports.
• An Independent Support Broker must be willing to undergo a criminal background
  check and complete the DHS minimum training requirements.
  

Before interviewing people who are applying to be your Independent Support Broker, think about the following:

• What type of people do you get along with? Calm people? Energetic people?
  Quiet or talkative people? People your own age? Younger? Older?
  
• What type of people do you trust to help you?
• Do you want your Independent Support Broker to be your friend or just get the
  job done?
  
• How do you want your Independent Support Broker to work with your family,
  friends, and service providers?
  
• Is there information you want to keep private?
• Are there things you want to do by yourself?
• What questions can you ask to make sure you hire an Independent Support Broker
  who will work well with you?
  

Some questions you might want to ask in your Independent Support Broker interviews:

• Do you have experience supporting people with lives similar to mine?
• If people want a change in their life, how have you helped people make those changes?
• If people want things to stay exactly the same, is that okay?
• How many people do you work with?
• How well do you know about local services in my community? How connected are you to my community?
• How often can I expect to see you? What if I need some extra help for a short time?
• Do you have a good relationship with provider agencies?
• How have you been an advocate for the people you work with now?
• How do you handle situations when people on a team have different opinions or are not getting along?
• How would you help me understand my budget?
• How would you help me plan for my future and help me achieve my goals?
• How can I find out what the people you support think about you?
• How often would you want me to tell you how you are doing?
• How do you learn about the things Independent Support Brokers are supposed to know?

After you have interviewed Independent Support Broker applicants, think about the following questions to help you decide who the best person is to be your Independent Support Broker:

• Does he or she seem to respect and honor your opinions?
• Do you feel he or she will be on your side and be your advocate?
• Is he or she well organized?
• How many important relationships and connections does he or she have in
  your community?
  
• Do you trust him or her to do good work for you?
• Does he or she see you the same way you see yourself?

Once you have hired an Independent Support Broker...

• They will get to know you and your family if they don’t already.
• They will help you make a plan that balances the support you need and want with the money you have to spend. This plan will also help you identify your goals and hopes for the future.
• They will help you complete your Individual Budget which shows how you plan to spend your service dollars.
• Your Independent Support Broker can help you complete time cards if you
  have questions.
  
• They can meet with you and/or your support team regularly at your request to make sure your plan is working or to help you make the changes you want.
• They can help you if the people who work for you or support you disagree about the best way to help you.
• They must help you review your plan at least once every three months but you can change it more often.

If you become unhappy with your Independent Support Broker, remember you can change your Independent Support Broker like you can change any service provider or employee.

C hapter 4: Planning Your Individual Budget

This is the time to dream and develop a “vision” of what you want in your life!

Your Independent Support Broker will help develop a plan with you. You are encouraged to ask others who you trust to help. This might include your family, friends, neighbors, co-employees, paid professionals or your personal network of support. Together, you will also discuss ideas for implementing your plan and changing it when necessary.

Your Independent Support Broker will help you to develop, implement, and change your plan as needed. He or she will write down the plan and share it with your freely chosen personal network of support. Your plan should state what support you want and need, name who will provide the support, when it will be provided and how much it will cost. Your plan should also include things that you want that do not cost money. Some free things that are important to people are time to spend with family, favorite foods, favorite activities, club or church memberships, or spending time at favorite neighborhood hang-outs. All plans need to say how you are going to address your safety and health needs.

Some people think that people with significant disabilities or frail elders are not able to be involved in the decision-making process about their lives. You should be as involved in the decision-making as much as possible. Your Independent Support Broker’s job is to guarantee your involvement! Having a strong circle of friends and loved ones can help ensure that your needs, preferences, and priorities are honored and met.

Individual Budget planning helps you identify what you like and don’t like, your needs, and priorities!

Your Individual Budget can be reviewed regularly by you and your friends, family and trusted allies. This helps make sure your plan describes your support needs accurately. At times, you and members of your personal network of support may disagree about support needs or personal goals. This often happens when you want to try something

new that other people think sounds too risky. A good Independent Support Broker will help you express your opinions, while listening respectfully to the people who are important to you. Your Independent Support Broker can help you resolve these conflicts to make sure that your support needs and wants are met and the people important to you continue to work as a team. A strong group of people who care about you will encourage you to try new things and look out for your safety and health too.

The Consumer Choices Option gives you the opportunity to take the responsibility for planning and controlling resources to make it possible for you to live in your home and community. Services and goods purchased in your Individual Budget are intended to make it possible for you to live and stay in your home and community. You and your Independent Support Broker are encouraged to be as creative as possible when developing your Individual Budget. The following are examples of services, supports and other items in each category that you may be purchase from non-traditional Medicaid providers:

Self-directed Personal Care

The supports listed below can help you in your home or community and would be provided mainly by your employee(s). The following are examples of things that can be covered:

• Cleaning services ^● Medication management
• Homemaking tasks ^● Personal grooming assistance
• Laundry assistance ^● Assistance with mobility transfers
• Supervision ^● Meal Preparation
• Lawn care ^● Respite
• Snow removal ^● Shopping
• Showering assistance ^● Transportation

Self-directed Community and Employment Supports

These supports help you live and work in your community. These supports would be provided primarily by your employee. The following are examples of things that can be covered:

• Self-direction and self-advocacy ^● Supports to maintain a job
  ●
  
• skills development Grooming skills development
• Training on use of medical equipment ^● Cooking skills development
• Personal and home skills development ^● Cleaning skills development
• Time and money management ^● Utilization of public transportation skills development skills development
• Social skills development training ^● Companionship
• Career preparation skills ^● Supports to attend social activities
• Career counseling ^● Safety and emergency preparedness
• Job Hunting/Career placement skills development
• Work place personal assistance

Individual Directed Goods and Services

Individual directed goods and services are services, equipment or supplies not otherwise provided through the Medicaid state plan that address an identified need in the service plan. The item or services would decrease the need for other Medicaid services; and/or promote inclusion in the community; and/or increase your safety in your home or community. These items or services would primarily be purchased from a community business. The following are examples of things that can be covered:

• Assistive devices ^● Laundry services ^● Job Hunting/Career placement
• Cooking services/home ^● Handyman services ^● Employee advertising delivered meals Lawn care services Appliances for independence
• Medical equipment ^● Snow removal ^● Bus pass
• Home modifications ^● Errand services ^● Taxi/transportation service
• Vehicle modifications ^● Career preparation skills ^● Workers Compensation
• Cleaning services ^● Career counseling ^● Other

These lists do not include everything. Supports, goods and services not in these lists may be purchased only with prior approval through the Iowa Medicaid Enterprise.

An Individualized Budget should be your blueprint for the “good life”!

Approval process for other supports and goods and services

If other supports, goods and services are needed that are not included in this list, you will need to describe the them in the description box on your Individual Budget form. Your Financial Management Service will let you know that your individual budget has been approved. There may be times when you will be asked to provide further information about the need of these items, goods or services before it can be approved.

Items that will not be allowed on your Individual Budget: room and board, childcare and personal entertainment items.

Deciding on Supports:

Your Individual Budget will document your support needs and priorities. It will describe the things that maintain and improve your quality of life. During the planning process, you and others will decide how to arrange these supports in a way that meets your needs.

Everyone’s Individual Budget is different. One person may choose to purchase support entirely from agencies that specialize in helping people with disabilities or older adults. Another may choose a combination of traditional provider agencies or non-traditional provider agencies such as hiring a co-worker to be a job coach or a neighbor to help you with housekeeping. You may decide not to utilize agency support, but instead hire your own staff. The only limitation to choosing support is to stay within your monthly allowance determined by the case manager/service worker.

Things to think about when developing your Individual Budget:

• What do you want your life to look like in the next 12 months? 2 years? 5 years?
• What do you really need to stay healthy and safe?
• What support is important to you?
• What supports cost money? How can your family, friends, or your community
  connections help?
  
• If you can’t afford everything you want, what are your most important priorities?
• If there are personal funds available, how can these help you get what you want?
• Can you get more of the support you want if you share staff, save money, have a housemate, go out with friends, share a job, etc.?
• Be specific; decide who will help you do what, by when. If you’re not getting the help you need, decide who will help you straighten things out.

Some ideas for learning about the types of support that others use:

• Ask Independent Support Brokers about the different types of supports that
  people use.
  
• Contact your case manager/service worker.
• Talk with other consumers who receive support services and their family members.
• Conduct informational interviews with your service providers and employees.
• Consider services typically provided to people without disabilities. For example, a cleaning service may be a more efficient use of money than paying a supported community living provider to clean your home. Also, many grocery stores have delivery service where you can call in an order and pay to have groceries delivered.
• Think about community connections! Taking a walk in your neighborhood, finding a favorite hang-out, volunteering at the community center, or attending a local place of worship all create feelings of belonging to the community.

An acceptable plan is one you develop with your Independent Support Broker and others who know you best, meets your health and safety needs, and is within your monthly allowance.

C hapter 5: Designing Supports

After you select an Independent Support Broker and your initial Individual Budget is written, it is time to figure out who will provide the supports described in your plan. The person-centered planning process will create many ideas about how the supports can be carried out. Your Independent Support Broker will help you put your plan into action.

It’s Your Life...You get to choose what you want to create and how you want to create it...how to create what you want...and want what you create!

First Steps

It’s time to think creatively!

Start by thinking about what you need. This may be different from what you want. Often, there are things you can’t afford and you can’t figure out how to make it affordable.

Questions to ask yourself when thinking about what help you need?

• Do I need help cleaning my house?
• Do I need help cooking?
• How do I make sure I am safe in my house?
• Do I need help finding a job?
• Do I need help at my job?
• Do I need help getting to my job?
• Do I need help getting up and ready in the morning?

Consider Your Options

• Talk with your Independent Support Broker about who can help you reach the goals in your Individual Budget.
• Prepare to compromise. There can be problems in getting the right services.
• There may not be enough support employees for all the people who need help.
• There may not be as much funding available as you would like.
• Someone else may get services before you get them. That happens when someone is having a crisis and needs services immediately. Although it is frustrating to have to wait or share resources, your Independent Support Broker will continue to work with you on your goals.

Some Ideas

• Pool resources with someone else. Maybe you can afford some of what you want; someone else might be in the same situation.
• Share resources with a friend. You might like to find a friend to do something with you. Perhaps you can share a support person to make that happen.
• Have a housemate. Perhaps you thought that you wanted to live alone. However, it may be too expensive to live on your own and to afford support staff to help you. A housemate could be your friend and a support employee too.
• Check other funding sources. Some examples may be:
• The Social Security Office
• The Iowa Division of Vocational Rehabilitation Services
• Iowa Workforce Development
• Section 8 provides assistance with rent for housing.

^● Families and friends might help.