May 17, 2023
When There Are 269: What Medicaid Waivers and an Area Code Have in Common
The late Ruth Bader Ginsburg was once asked, “When will there be enough [women on the Supreme Court]?” she said, “I say ‘When there are nine,’ people are shocked. But there’d been nine men, and nobody’s ever raised a question about that.”
When we are asked, “How many Medicaid waivers should allow for self-determination?” we answer with, “When there are 269. Yes, that’s all of them.”
What is Self-Determination?
Self-determination is the ability to have a say in your own life and care. It is often an alternative to traditional services, such as an agency model.
In the early 1990s, many states began to offer “consumer-directed” personal assistant services. A few years later, grants enabled self-determination programs to be developed in 19 states. Since then, more states have adopted and grown their self-determination programs. Currently, more than 1.2 million people direct their own services in the United States.
Self-determination has proven to be beneficial for many people. A clinical study showed the positive effect of social support on elderly patients with long-term care needs. And early in the COVID-19 pandemic, infection rates were lower for Connecticut residents who self-directed than those in residential settings.
Current Medicaid Waivers
There are different ways that states can give people the option to self-direct. Some of these options include:
- Home and Community-Based Services State Plan Option- 1915(i)
- Community First Choice-1915(k)
- Self-Directed Personal Assistance Services State Plan Option-1915(j)
- Home and Community-Based Services Waiver Programs- 1915(c)
269 HCBS waivers currently exist in the United States. But only half of them let people self-direct their own support. Applied Self-Direction’s website has an interactive map of programs by state.
The Connection of 269 to GT’s Home
GT Independence hopes to become synonymous with self-direction. So it’s fitting that the area code of our headquarters—Sturgis, Michigan—is also 269.
We may have started in a small town, but we believe that everyone should have the opportunity to direct their own care. And that won’t happen until all 269 Medicaid waivers allow for self-determination.
How You Can Help Us Achieve Our Goal
Medicaid waivers are what enable self-determination programs to be available in a state. Some states offer many waivers, and some have only a few. This interactive map outlines each state and what programs are offered there.
Once you know what is offered where you live, we encourage you to contact your representatives in Congress. Ask them to support legislation that expands HCBS funding. And especially encourage them to support self-determination programs in your state.