In recent years, several initiatives in publicly financed services for older persons with disabilities have focused on supporting community residence through greater beneficiary control and flexibility in choosing the services and supports that best meet their needs. This movement has gained strength from state efforts to "rebalance" public long term care spending from institutional care to community-based alternatives. State innovations in Medicaid-financed community based long term care have tended to move programs along a continuum from the traditional set of service benefits toward the ultimate flexibility that may be achieved with a beneficiary-managed individual budget to purchase a preferred menu of services and supports. The beneficiary-managed individual budget model originated in the Cash and Counseling Demonstration. This brief describes the evolution of the model since the original demonstration and provides an overview of state activity as of January 2006 in developing individual budget model programs for elderly beneficiaries.
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