Elizabeth Martin, CEO at Consumer Directed Choices Inc., provided insight at Tellus’ second
annual national EVV forum last month on how to successfully implement EVV in a fast-growing
segment: the self-directed market.
Self-directed services, as defined by Medicaid means that participants, or their representatives
“have decision-making authority over certain services and take direct responsibility to manage
their services with the assistance of a system of available supports,” she said.
The self-directed service model is an alternative to the traditional agency delivery model.
Self-direction allows participants to be responsible for managing all aspects of service delivery
in a person-centered planning process. The model promotes personal choice and control over
the delivery of waiver and state plan services, including who provides the services and how they
Martin’s Consumer Directed Choices (CDC) is a non-profit advocate promoting self-directed
services for seniors, people with disabilities and their families.
She said, EVV will be successful in self-directed care if people welcome the model in their
“hearts and minds” and absorb the true purpose and philosophy of self-direction, which is
freedom and control.
“It [self-direction] is different; it’s not just home care,” she said, noting more than half of these
consumers are self-directing and managing their own programs while the other portion have a
representative operating on their behalf. Those typically are family members, parents of an
adult child or a child for their parent.
About 40 percent of self-directed consumers employ family members. The vast majority hire
people they have no relationship with, Martin added.
There are both challenges and opportunities for making EVV work in self-directed care.
People with disabilities have the right to look at all of their options and make decisions and
sometimes those decisions are good, and sometimes those decisions are bad — everybody
enjoys that right, Martin noted, comparing a risky decision she made in the consumer world
with what disabled individuals are facing in the self-directed world.
“People with disabilities have the dignity of risk,” she said.
Participants are recruiting, hiring and terminating people, deciding tasks, and when and how
they are performed. It’s the participants who verify hours, and that’s where the fraud control
comes in in self-direction.
CMS’ limited guidance has created challenges and opportunities in the self-directed space.
Location-based verification “is a big one,” she said. States have to make sure EVV systems do
that, but it must be minimally burdensome on workers and participants. Self-direction is more
about being fluid, and about the purpose of “living your life.”
The big challenge with EVV is that it was designed for industry-based care, she said, adding that
scheduling and location aren’t top priorities in self-direction. Many times, services are provided
whenever and where ever it’s most convenient. The technology can be seen as intrusive. Geo-
fencing doesn’t work because self-direction is intended to enable greater freedom, not restrict
So how do you make it work? she asked.
Get feedback from participants and have the right attitude, Martin opined. Many participants
want to better manage their own program, so utilizing EVV to provide efficiencies and tools is a
way to make that happen.
“You have to come from that angle to make EVV work,” she said.
Another suggestion she made was building an EVV system that can be turned on or off based
on participant wishes. In her experience, Martin found they want the flexibility to control
scheduling and are often excited to transition from paper record-keeping to online. Having
control over what type of verification system they use, whether that’s cellphone, tablet,
computer or otherwise is also high on the wish list.
EVV for self-directed care should also be user-friendly and administratively easy, Martin noted.
If approached respectfully, many will be keen on the practicalities of the system.